Clinical and rhinostereometric assessment of nasal mucosal swelling during histamine challenge

The correlation between the subjective sensation of nasal stuffiness and nasal mucosal swelling measured with rhinostereometry during histamine challenge was studied in 13 healthy subjects. To permit a study of the entire range from decongestion to maximal congestion, the mucosa was pre-treated with a local vasoconstrictor 1 h before it was challenged with eight doses of increasing concentrations of histamine applied to one side of the nose. Ten minutes after each application, the subject estimated stuffiness on the challenged side, using a 100 mm visual analogue scale. The amount of mucosal swelling was measured with rhinostereometry. In 12 of 13 individuals and in the group as a whole, there was a strong positive correlation between a feeling of nasal stuffiness and the degree of mucosal swelling with this nasal provocation model (R = 0.59; P <0.001).     

Nasal mucosal swelling and reactivity during a menstrual cycle

INTRODUCTION: Nasal stuffiness is a great problem for many women in the later part of pregnancy. OBJECTIVE: This study was performed to evaluate whether oestrogen causes nasal congestion and/or a hyperreactive reaction of the nasal mucosa. MATERIAL AND METHODS: Ten healthy fertile women were examined during menstruation. Nasal mucosal congestion was studied with rhinostereometry and acoustic rhinometry. The nasal mucosa was challenged with 3 doses of histamine solution to study nasal reactivity. Measurements were made 3 times during menstruation. To find the exact time of ovulation, when oestrogen reaches its peak value, intravaginal ultrasound tests were done and blood samples taken, to determine the oestrogen and progesterone levels. RESULTS: The nasal mucosa became hyperreactive to histamine in connection with ovulation, when the blood level of oestrogen reached its peak. This does not occur during the menstrual or the luteal phase. No significant alteration was found in the baseline position during the menstruation. CONCLUSION: There is a connection between high oestrogen level and nasal mucosal reactivity.     

The limitations of peak nasal flow measurement

The Youlten Peak Nasal Flow Meter is a convenient device for obtaining objective measurements of nasal patency and gives static values which correlate well—though inversely—with resistance measured by rhinomanometry. In this study peak nasal flow and nasal resistance are compared before and after intranasal challenge using histamine. The comparatively small change in nasal resistance induced by low-dose histamine is not reliably detected by the peak flow meter. Large changes in nasal resistance with a higher dose of histamine are reflected by significant but small changes in peak nasal inspiratory flow. It is concluded that changes in nasal patency as measured by the Youlten meter are an insensitive measure of nasal patency compared with rhinomanometrically measured resistance changes. Continued use of the latter is recommended for physiological research.     

A comparison of the sensitivity of manometric rhinometry,acoustic rhinometry,rhinomanometry and nasal peak flow to detect the decongestant effect of xylometazoline

A study has been undertaken to compare the sensitivity of manometric rhinometry, rhinomanometry, nasal peak flow and acoustic rhinometry to detect the decongestant effect of xylometazoline. Twenty healthy volunteers were investigated before and after decongestion. The sensitivity of all four methods varied from 80 to 95%. These differences were not significant. Manometric rhinometry, a new method of investigating nasal physiology, is as sensitive as more established methods.     

Nasal and bronchial histamine responsiveness in pollen-exposed patients with seasonal rhinitis

In a previous study, we found an increased nasal responsiveness as measured by rhinostereometry and histamine challenge out of season in a sample of 12 patients suffering mainly from hay fever. The aim of the present study was to investigate whether airway responsiveness in these patients was further increased after direct pollen exposure, after a single nasal pollen provocation as well as by repeated exposure during the pollen season. In spite of increased allergic symptoms, the basal degree of nasal mucosal swelling was unchanged before histamine challenge under these circumstances. After histamine challenge, nasal mucosal swelling was increased in the same way over the seasons. Also bronchial responsiveness was unchanged during the pollen season. It correlated to frequent sneezing following nasal histamine challenge during the season (p = 0.0071, r = -0.74). We interpret the results as an indication of a continuos airway inflammation regardless of season in these patients with pollen allergy, with acute symptoms added on direct exposure to the allergen.     

Evaluation of rhinostereometry compared with acoustic rhinometry

Measurement of the nasal mucosa is a challenging task. There are many different methods; each with advantages and disadvantages. In the last decade two new methods have been used extensively: acoustic rhinometry and rhinostereometry. Many studies with rhinostereometry have shown interesting results. However, there have been doubts about this method, since only a few investigators have used it, and it has never been compared with other methods. On the other hand, the acoustic rhinometer has been compared with many other methods. In this study, we compare the results of measurements with acoustic rhinometry and rhinostereometry. Thirty patients with vasomotor rhinitis participated in the study. They were challenged with three histamine concentrations on two occasions. resulting in 180 observations with each method. The results were compared with each other using the linear correlation test, and showed a poor but significant correlation (p < 0.01. r = 0.25). We conclude that acoustic rhinometry and rhinostereometry are sensitive methods for studying nasal mucosal swelling, but that there is poor correlation between the two methods.     

Nasal Histamine Reactivity; Relationships to Skin-test Responses,Allergen Provocation and Symptom Severity in Patients with Long-continuing Allergic Rhinitis

It has been reported that skin-test reactivity and rhinitis symptom severity weaken in the course of time. A corresponding weakening might also be seen in non-specific nasal hyper-reactivity, but the relationships of these responses are poorly understood. Our aim was to measure nasal responsiveness to histamine in a series of patients with long-continuing allergic rhinitis and to compare these measurements with skin test responses, allergen provocation and changes in severity of allergic rhinitis symptoms. A total of 73 patients in whom allergic rhinitis had been verified over 20 years earlier were re-interviewed and re-investigated. Skin prick tests with common allergens were performed and the presence of nasal allergy was confirmed by allergen provocation. Non-specific nasal hyper-reactivity was determined with nasal histamine challenge using four concentrations of histamine phosphate. The response was registered by counting sneezes, recording changes in nasal discharge and mucosal swelling and measuring nasal airway resistance. Sneezing and discharge scores showed that milder non-specific nasal hyper-reactivity was associated with lack of reactivity in skin prick tests and nasal allergen challenge. No association was observed between allergy test results and changes in nasal airway resistance during the histamine provocation. In most patients the symptoms of rhinitis had become milder or disappeared during the follow-up, but the results of the histamine challenge showed no relationship with the changes in symptom severity. In patients with allergic rhinitis, reactivity to histamine is associated with a concomitant change in skin and nasal mucosal reactivity to allergens.     

Nasal histamine reactivity; relationships to skin-test responses, allergen provocation and symptom severity in patients with long-continuing allergic rhinitis

It has been reported that skin-test reactivity and rhinitis symptom severity weaken in the course of time. A corresponding weakening might also be seen in non-specific nasal hyper-reactivity, but the relationships of these responses are poorly understood. Our aim was to measure nasal responsiveness to histamine in a series of patients with long-continuing allergic rhinitis and to compare these measurements with skin test responses, allergen provocation and changes in severity of allergic rhinitis symptoms. A total of 73 patients in whom allergic rhinitis had been verified over 20 years earlier were re-interviewed and re-investigated. Skin prick tests with common allergens were performed and the presence of nasal allergy was confirmed by allergen provocation. Non-specific nasal hyper-reactivity was determined with nasal histamine challenge using four concentrations of histamine phosphate. The response was registered by counting sneezes, recording changes in nasal discharge and mucosal swelling and measuring nasal airway resistance. Sneezing and discharge scores showed that milder non-specific nasal hyper-reactivity was associated with lack of reactivity in skin prick tests and nasal allergen challenge. No association was observed between allergy test results and changes in nasal airway resistance during the histamine provocation. In most patients the symptoms of rhinitis had become milder or disappeared during the follow-up, but the results of the histamine challenge showed no relationship with the changes in symptom severity. In patients with allergic rhinitis, reactivity to histamine is associated with a concomitant change in skin and nasal mucosal reactivity to allergens.     

Correlation of subjective sensation of nasal patency with nasal inspiratory peak flow rate*

To determine the relationship between subjective sensation of nasal patency and objective measurement of nasal inspiratory peak flow rate, a longitudinal study was conducted using healthy volunteers. Five healthy medical practitioners, one woman and 4 men, aged 24–34 years, made daily subjective estimations of their sensation of nasal patency on a 10cm visual analogue scale. This was followed immediately by measurements of nasal inspiratory peak flow rate using a Youlten meter, repeated on at least 25 days per subject. Correlation coefficient and regression lines for subjective nasal patency on nasal inspiratory peak flow rate were calculated. One hundred and sixty nine sets of observations were made, range 25–44 per subject. Each subject showed strong evidence (P < 0.01) of positive correlation between subjective nasal patency score and nasal inspiratory peak flow rate. There was strong evidence (P < 0.001) that different regression lines are needed for different subjects, but no evidence that the lines are not parallel. Subjective sensation of nasal patency is strongly correlated with objective nasal patency, as measured by peak inspiratory flow rate. This relationship varies between individuals. Measurement of nasal inspiratory peak flow rate may be a valuable objective test of nasal patency, and is quick and simple to perform.     

Antigen induced histamine release from mucosa in nasal polyposis

This study was designed to detect local immediate-type hypersensitivity in patients with nasal polyposis. For this purpose, 20 patients were tested for antigen-induced histamine release from biopsies of nasal mucosa and nasal polyps. Compared with controls, histamine-release was increased after incubation with bacterial but not synthetic antigens. Fourteen patients allergic to pollen were studied; biopsy specimens of their nasal mucosa released more histamine on incubation with pollen than with synthetic antigens. These findings suggest that, like pollen allergy, nasal polyposis is a manifestation of immediate type hypersensitivity, possibly to bacterial antigens.     

Important factors in the nasal manifestation of allergy

To elucidate whether or not histamine can be released by antigen from the nasal surface layer in sufficient quantities to produce nasal manifestation of allergy and which among three factors, i.e., the number of surface basophilic cells, the histamine release from these cells, or the mucosal histamine sensitivity, is the most responsible for the degree of nasal allergen provocation, we determined the allergen-induced histamine release from specimens of the mucus-epithelial layer of patients with nasal allergy and also counted the number of basophilic cells in these specimens after staining by Hansel's method. In addition, we evaluated the histamine sensitivity of the mucosa by the end-point test. The net histamine content released from the specimens of the nasal surface ranged from 25.5--310.7 microgram/cm3, which was found to be sufficient to produce nasal manifestation of allergy. Thye correlation coefficients were calculated as the relationships between the degree of provocation reaction and the level of histamine released from the nasal surface, the basophilic cell number, histamine releasability and histamine reactivity. these values were 0.645, 0.440, 0.481, and 0.155, respectively, and, when they were analyzed statistically, the most significant correlations to the degree of provocation reaction were found to be those between the degree of provocation reaction and the histamine content released from the nasal surface, the basophilic cell number, or the histamine releasability and histamine reactivity (p less than 0.01), in that order.     

Role of Vascular Reflex in Nasal Mucosal Swelling in Nasal Allergy

Objective: In patients with nasal allergy, antigen challenge on the unilateral nasal mucosa results in nasal secretion not only in the ipsilateral but also in the contralateral nasal cavities that can be inhibited almost completely by premedication with atropine sulfate. The present study was performed to elucidate if centrally mediated vascular reflex induced by antigen challenge plays a role in nasal mucosal swelling in subjects with nasal allergy. Methods: Variations of mucosal swelling and mucosal blood flow in the ipsilateral and the contralateral nasal cavities after unilateral antigen challenge were evaluated by acoustic rhinometry and laser Doppler flowmetry in 20 patients with perennial nasal allergy. Results: Unilateral antigen challenge caused ipsilateral and contralateral nasal mucosal swelling in 17 and 13 patients, respectively. Incidence of contralateral nasal mucosal swelling after unilateral antigen challenge was significantly higher compared with that after control disc challenge (P < .001). In 10 patients in whom unilateral antigen challenge caused bilateral nasal mucosal swelling, significant swelling of the nasal mucosa lasted for more than 30 minutes in the ipsilateral nasal cavity after antigen challenge compared with only 15 minutes in the contralateral nasal cavity. Peak values of contralateral mucosal swelling were 45.3% of those of ipsilateral nasal mucosa. Conclusions: Centrally mediated vascular reflex is partially involved in the onset of nasal mucosal swelling observed after antigen challenge in subjects with nasal allergy. However, nasal mucosal swelling that persists and proceeds even 20 minutes after antigen challenge is caused by the direct effects of chemical mediators on the nasal vasculature.     

特异性鼻粘膜激发试验中鼻气道的反应性

目的：探讨对特异性鼻粘膜激试验（ＳＮＰＴ）阳性的评价方法。方法：对３０例常年性变应性鼻炎患者（鼻炎组）和１４例正常成年人（对照组）进行ＳＮＰＴ，观察鼻部症状及鼻气道阻力变化。结果：激发后，鼻炎组在多数患者在０．５￣３．０ｍｉｎ内出现鼻痒、喷嚏、流清滋等症状。连续喷嚏５个以上者占８３．３％，与对照组（２１．４％）之间有显著性差异（Ｐ〈０．０１）；鼻腔总阻力和激发侧鼻阻力增加比例，两组间有明显差异，而     

The naso-oral index: a more valid measure than peak flow rate?

Using a modified respiratory spirometer, we set out to determine whether the nasal peak flow rate, or a new parameter the naso-oral 1 second index (the ratio between the nasal forced inspiratory ‘1 second’ volume and the oral forced inspiratory ‘1 second’ volume) correlated with anterior rhinomanometry and visual analogue scores. Ten patients undergoing nasal surgery for nasal obstruction were recruited into the study. The naso-oral 1 second index consistently correlated better than the nasal peak flow rate with anterior rhinomanometry. The naso-oral index also correlated better than nasal peak flow with visual analogue scores. Correlation was best demonstrated when assessing the benefit gained by patients from surgery. The naso-oral index is a potentially useful clinical parameter, and correlates acceptably well both with visual analogue scores and anterior rhinomanometry.     

Nasal mucosa reaction. A model for mucosal reaction during challenge.

Rhinological symptoms in aspects of hyperreactivity and allergy are increasing problems. Previous reports on this subject are based on studies of airway obstruction (rhinomanometry), secreted substances during challenge, and symptom scores. To be able to define and evaluate the pathological reactions in nasal hyperreactivity and allergy, it is necessary to find principles to describe and standardize the reactions of the healthy nasal mucosa. The aim of this study was to examine congestion of the nasal mucosa in healthy volunteers. Existing measuring methods, in this aspect, are either indirect or not accurate enough for this purpose. With the development of rhinostereometry, an optical measuring method, it is possible to record nasal mucosa congestion with high accuracy. A nasal challenge test was made in healthy volunteers with gradually raised concentrations of a histamine solution, which was applied to the inferior concha on the right side. Recordings of the mucosal congestion were made with rhinostereometry. We found that it is possible, with statistical significance, to standardize the reactions of the healthy nasal mucosa: There is no congestion more than 0.4 mm with a histamine concentration of less than 4 mg/ml (p less than 0.05); congestion of more than 0.4 mm is present at histamine concentrations of 16 mg/ml (p less than 0.05).     

Important factors in the nasal manifestation of allergy

Summary To elucidate whether or not histamine can be released by antigen from the nasal surface layer in sufficient quantities to produce nasal manifestation of allergy and which among three factors, i.e., the number of surface basophilic cells, the histamine release from these cells, or the mucosal histamine sensitivity, is the most responsible for the degree of nasal allergen provocation, we determined the allergen-induced histamine release from specimens of the mucus-epithelial layer of patients with nasal allergy and also counted the number of basophilic cells in these specimens after staining by Hansel's method. In addition, we evaluated the histamine sensitivity of the mucosa by the end-point test.The net histamine content released from the specimens of the nasal surface ranged from 25.5–310.7 g/cm³, which was found to be sufficient to produce nasal manifestation of allergy. The correlation coefficients were calculated as the relationships between the degree of provocation reaction and the level of histamine released from the nasal surface, the basophilic cell number, histamine releasability and histamine reactivity. These values were 0.645, 0.440, 0.481, and 0.155, respectively, and, when they were analyzed statistically, the most significant correlations to the degree of provocation reaction were found to be those between the degree of provocation reaction and the histamine content released from the nasal surface, the basophilic cell number, or the histamine releasability and histamine reactivity (p<0.01), in that order.     

Changes in nasal mucosal blood flux and air-flow resistance on unilateral histamine challenge

To investigate reflex vascular control in the nose, we challenged each side of the nose with 0.9% saline and histamine (0.3 mg aqueous) and observed changes in unilateral nasal airway resistance (Rnaw) and laser doppler flux (LDF) in response to contra-lateral and ipsilateral challenge in eight normal subjects. Preliminary studies demonstrated that the preferred site for observation of LDF was the nasal septum (same-day concordance 0.920; inferior turbinate 0.307). Ipsilateral contra-lateral saline induced no significant change to either parameter. Ipsilateral histamine produced a highly significant rise in LDF (757 arbitrary units sem 94 at 3 min; baseline 489 sem 75: P < 0.05) and Rnaw (baseline: 3.10, sem 0.52; 5min: 8.81, sem 2.09 cmH₂O/1/s: P < 0.01). Contra-lateral histamine produced a significant P < 0.05) fall in both (LDF 317, sem 24 at 3 min; Rnaw 2.67, sem 0.78 cm H₂O/1/s at 6 min). This previously unrecorded observation suggests a neural reflex that increases the patency of the contralateral nostril after unilateteral obstruction is provoked.     

Effect of diesel exhaust on guinea pig nasal mucosa.

In this study using guinea pigs, we investigated the effects of diesel exhaust (DE) containing diesel exhaust particulate (DEP) on 1) vascular permeability induced by histamine, 2) nasal mucosal permeability to horseradish peroxidase (HRP), and 3) eosinophilic epithelial infiltration. The vascular permeability induced by histamine was enhanced significantly and dose-dependently in DE-exposed guinea pigs. The HRP reaction products in epithelial cells and intercellular spaces were significantly and dose-dependently increased in those guinea pigs. Eosinophil infiltration into the epithelial layer was significantly increased in guinea pigs exposed to DE containing 3.2 mg/m3 DEP, and the reactivity of the nasal mucosa to histamine solution applied on the nasal mucosa was significantly enhanced in those guinea pigs. These findings suggest that DE may play an important role not only in promoting nasal hyperreactivity induced by the enhancement of absorption of antigen through the nasal epithelium, but also in inducing eosinophil infiltration in nasal mucosa and enhancing nasal mucosal reactivity.     

Increased nasal airflow with budesonide compared with desloratadine during the allergy season

OBJECTIVE: To compare the effects of desloratadine, an H1-blocking antihistamine, and budesonide, an intranasal corticosteroid, on nasal peak inspiratory flow (NPIF) in patients with seasonal allergic rhinitis. DESIGN: We performed a randomized, double-blind, double-dummy, parallel study comparing oral desloratadine, 5 mg/d (n = 31), and budesonide, 32 mug/d per nostril (n = 30), for 2 weeks during the spring allergy season. MAIN OUTCOME MEASURES: Subjects recorded NPIF and nasal symptoms twice daily. Baseline measurements were obtained before initiation of treatment. The Rhinoconjunctivitis Quality of Life Questionnaire was completed at baseline and after treatment. RESULTS: Desloratadine and budesonide caused a significant increase in NPIF compared with baseline on the evening of the first dose (P < .01). Budesonide, however, led to a significantly greater increase in NPIF than did desloratadine when the change from baseline was compared for the entire treatment period (median, 475 vs 150 L/min; P = .01). Both treatments resulted in clinically significant reductions of the individual domains and overall scores on the Rhinoconjunctivitis Quality of Life Questionnaire (P < .01). There was a significant reduction in total symptom scores (P < or = .01) compared with baseline during all treatment days in both treatment groups, with no statistically significant differences between treatments (median, -60.0 vs -59.5; P = .67). CONCLUSIONS: Both treatments led to significant improvements in NPIF, but the improvement was greater with the intranasal corticosteroid. Both treatments improved quality of life and reduced symptoms. The difference between the objective and subjective outcomes probably reflects the small sample size, the low pollen counts for the season, and the greater variability in subjective compared with objective measures.     

Nasal congestion during the menstrual cycle

Oestrogens have been considered to cause nasal congestion during the menstrual cycle and during pregnancy. The aim of the present study was to evaluate the degree of nasal congestion during the menstrual cycle in healthy women. Nasal peak expiratory flow (nPEF) was measured and subjective nasal stuffiness was scored morning and evening by 27 women for 3 months and by 14 women for 6 months. During the menstrual days, when the serum oestrogen level is lowest, the morning nPEFs were significantly lower compared with the rest of the cycle (P= 0.0012). The difference was most pronounced for the second day of the cycle (P= 0.00034). The correlation between nPEFs and the subjective scores was high (R= 0.98), while the coefficient of variation within the series of three nPEF recordings was low (6.4%). It is concluded that the nasal obstruction experienced during menstruation cannot be explained by increased serum levels of oestrogen.