Nasal allergy and nasal polyp with special reference to the mucosal IgE antibodies

Immunologic conditions were studied in 8 patients with nasal allergies and nasal polyps and in 20 patients with nasal polyps. The present study showed the following: Nasal polyp mucosa contains a low level of mucosal IgE antibodies; nasal polyp mucosa is devoid of or deficient in the capacity of producing IgE antibodies; the presence of mucosal IgE antibodies in nasal polyp mucosa does not always imply the clinical manifestation of nasal allergies, and the antigen and antibody interaction does not always result in nasal symptoms.     

Topical immunology of nasal allergy and mucosal IgE antibodies

Summary In the present study, the in vitro tissue-radioallergosorbent test (t-RAST) was performed in two groups of patients: one with perennial attacks of sneezing, serous hypersecretion and nasal congestion, the other with nasal congestion only. The results obtained were compared with those obtained by a series of conventional allergy tests. We then found that t-RAST provided objective data comparable to those obtained with serum-RAST and that the t-RAST is a reliable means of quantitatively detecting specific IgE antibodies in the nasal mucosa. t-RAST is of special value to diagnosticians because it is able to discern unequivocally and easily those patients with localized nasal allergy.     

Topical immunology of nasal allergy and mucosal IgE antibodies

In the present study, the in vitro tissue-radioallergosorbent test (t-RAST) was performed in two groups of patients: one with perennial attacks of sneezing, serous hypersecretion and nasal congestion, the other with nasal congestion only. The results obtained were compared with those obtained by a series of conventional allergy tests. We then found that t-RAST provided objective data comparable to those obtained with serum-RAST and that the t-RAST is a reliable means of quantitatively detecting specific IgE antibodies in the nasal mucosa. t-RAST is of special value to diagnosticians because it is able to discern unequivocally and easily those patients with localized nasal allergy.     

Nasal mucosal anaesthesia and airflow resistance

The effect of topical lidocaine solution on nasal airflow resistance was examined in five adult subjects with normal noses, seated and recumbent. The increasing use of upper airway anaesthesia in the investigation of upper airway function and the lack of published information concerning its effect on nasal airflow resistance led to this investigation. Nasal airflow resistance did not significantly change during 30 minutes observation following topical application of 4% lidocaine solution.     

Nasal mucosal temperature during respiration

One of the most important functions of the nose is heating the inspiratory air. The aim of the present study was to measure nasal mucosal temperature at defined intranasal sites during respiration, without interruption of nasal breathing. A total of 15 healthy volunteers was included in the study. A miniaturized thermocouple was used for continuous detection of the septal mucosal temperature in the nasal vestibule, the nasal valve area, the anterior turbinate area and the nasopharynx during respiration. The highest temperature values were measured at the end of expiration, the lowest values at the end of inspiration with a statistically significant difference (P < 0.005). Mean mucosal temperature ranged from 30.2 +/- 1.7 degrees C to 34.4 +/- 1.1 degrees C. Statistically there were significant differences between the detection sites during inspiration and expiration (P < 0.05). In our study, the temperature values of the nasal mucosa depend on the intranasal detection site and the respiratory cycle. We therefore conclude that whenever data of nasal mucosal temperature are published, it is absolutely essential to describe the precise site of detection and to give information about the time of detection in the respiratory cycle.     

Nasal reactions elicited by unilateral allergen challenge

Nasal reactions to unilateral allergen provocation were studied separately in both nasal cavities of 9 subjects with established seasonal allergic rhinitis. Three tests with the same allergen at the same concentration were performed in the same cavity at 48-h intervals. The parameters observed were clinical symptoms, changes in nasal airway resistance on rhinomanometry, and amount, weight and histamine content of the collected secretion. Nasal obstruction increased significantly on the provoked side but not contralaterally. Secretion increased symmetrically but the histamine content rose only on the provoked side. No priming effect was observed. The results are compatible with the view that the release of histamine has a 2-fold effect. Histamine directly caused vasodilatation of capacitance vessels and capillaries, which resulted in obstruction on the provoked side, and indirectly the histamine release led to stimulation of sensory nerve endings, which by triggering parasympathetic reflexes caused rhinorrhea in both nasal halves.     

Nasal mucosal involvement in lupus erythematosus

The involvement of oral, conjunctival and genital mucosa in lupus erythematosus (LE) has recently been described. Reports of nasal involvement have been sporadic. A prospective study was performed to assess the prevalence of nasal symptoms and signs in LE and to identify the incidence of deposition of immunoreactants in the nasal mucosa of patients with LE. Thirty-six patients with LE were studied; 21 had non-specific nasal symptoms and 12 had evidence of chronic inflammatory changes in the mucosa of the nasal cavity or in the vestibule (septal perforation, inflamed mucosa, vestibulitis). Immunoreactants were found in only 4 patients and did not correlate well with clinical evidence of disease. Nasal mucosal involvement in LE is underestimated and often overlooked in the assessment of such patients. Keywords lupus erythematosus nasal disease     

Nasal mucosal blood flow in atrophic rhinitis

Among many theories about the etiology of atrophic rhinitis with ozena, a reduced mucosal blood flow has been suggested, possibly caused by 'sympathetic spasm'. The nasal mucosal blood flow has been investigated in 6 patients with this disease before and after topical administration of a sympathomimetic drug. No difference in action compared to healthy subjects was found. Other pathophysiological mechanisms must be searched for.     

Nasal mucosal congestion after treatment with bromocriptine

Nine women were given bromocriptine a few days after delivery in order to inhibit lactation. Nasal airway resistance to airflow (NAR) was recorded and blood samples were taken before treatment with bromocriptine, 2 to 3 hours after the first dose of this drug, and after 3 to 5 days on this treatment. All the women had increased nasal congestion after bromocriptine and NAR rose significantly. The prolactin, estradiol, and progesterone hormone levels decreased significantly, but no significant difference was found in the levels of thyroid-stimulating hormone (TSH) and vasoactive intestinal polypeptide (VIP). The bromocriptine effect may be caused by different mechanisms.     

Nasal mucosal involvement in lupus erythematosus.

The involvement of oral, conjunctival and genital mucosa in lupus erythematosus (LE) has recently been described. Reports of nasal involvement have been sporadic. A prospective study was performed to assess the prevalence of nasal symptoms and signs in LE and to identify the incidence of deposition of immunoreactants in the nasal mucosa of patients with LE. Thirty-six patients with LE were studied; 21 had non-specific nasal symptoms and 12 had evidence of chronic inflammatory changes in the mucosa of the nasal cavity or in the vestibule (septal perforation, inflamed mucosa, vestibulitis). Immunoreactants were found in only 4 patients and did not correlate well with clinical evidence of disease. Nasal mucosal involvement in LE is underestimated and often overlooked in the assessment of such patients.     

Nasal mucosal blood flow at rest and during exercise

Nasal airway resistance increases at rest in the supine position and decreases during exercise due to changes of the thickness of the nasal mucosa regulated by the capacitance vessels. The resistance vessels regulating blood flow have not not been evaluated in these conditions before. In 15 healthy subjects the nasal mucosal blood flow was measured in rest and exercise with the 133Xe washout method. No change in blood flow was registered during exercise, which demonstrates that the blood flow and the blood content of the human nasal mucosa are not affected in the same way by exercise.     

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.     

Nasal mucosal changes in children with frequent infections

Children with frequent recurrent respiratory tract infections and constant mucopurulent secretion from the nose were thoroughly examined, including bacteriologic and immunologic analyses. Biopsy specimens from the nasal mucosa were investigated by light and electron microscopy. Eight different histopathologic factors were distinguished and evaluated in relation to the continual nasal discharge. The mucus production was increased, due to an increased number of goblet cells or submucosal glands. The mucus transport was impaired owing to a decreased number of ciliated cells or different deficiencies in the structure of the cilia. The secretion of periciliary fluid was altered due to dysfunction of microvilli-equipped cells and the availability of tissue fluid due to vascular changes. Leakage of tissue fluid partly reflects deficiencies in the epithelial lining. Purulent discharge was observed from microabscesses. Reactive changes in the nasal mucosa are described and discussed in relation to treatment schedules aimed at reducing short- and long-term discomfort and complications.     

Nasal mucosal temperature and the effect of acute infective rhinitis

Nasal mucosal temperature was measured in 71 healthy subjects with an electronic thermometer. No correlation was found between the nasal mucosal temperature and age or sex. An increased mucosal temperature was found in patients with acute rhinitis, an effect which is supposed to assist in the defence system against microorganisms. When measuring nasal mucosal temperature over a 7-h period at the same time as nasal airway resistance, there was no correlation between these factors, indicating that the temperature is independent of the state of the capacitance vessels.     

Nasal mucosal blood flow in patients with diabetes mellitus

Fifty patients with diabetes mellitus of varying duration were divided into two groups according to whether they were on treatment with insulin or not. Nasal mucosal blood flow was investigated and the results were compared with a reference material from healthy subjects, and were also related to the degree of retinopathy. Patients with diabetes mellitus had normal mucosal blood flow. There was no correlation between the duration of diabetes and nasal blood flow, nor was there any correlation between the degree of retinopathy and nasal blood flow. Diabetes mellitus does not seem to be accompanied by changes in blood flow in the nasal mucosa.     

Nasal lavage cytology and mucosal histopathological alterations in patients with rhinitis

IntroductionThe extent of epithelial lesion in allergic and non-allergic rhinitis and its association with inflammatory changes in nasal lavage has not been clarified.ObjectiveTo verify the association between the inflammatory cells in the nasal lavage, epithelial lesion extent and basement membrane thickness, in the nasal mucosa of patients with rhinitis; to determine the cutoff point of the percentage of eosinophils in the nasal lavage associated with the atopic patients.MethodsPatients with rhinitis and indication for septoplasty and (or) turbinectomy for turbinate hypertrophy were selected, and were submitted to allergy skin tests, nasal lavage with measurement of albumin and interleukin-8 levels, total and differential counting of cells, and mucosal histopathological analysis to determine the extent of epithelial lesion, and degree of basement membrane thickening.ResultsFifty-six patients with a median age of 24.5 years and a diagnosis of allergic rhinitis (n = 36) and non-allergic rhinitis (n = 20) were studied. In atopic subjects, allergy skin tests were positive for Dermatophagoides pteronyssinus in 35 (97.0%) and Lolium perenne in 18 (50.0%). Atopic subjects showed a higher clinical score index of rhinitis compared to non-atopic ones. The total count of cells, neutrophils, and levels of albumin and IL-8 were not different in the nasal lavage of atopic and non-atopic subjects. The cutoff point for eosinophil count in nasal fluid for the distinction between allergic rhinitis and non-allergic rhinitis was 4%. Some degree of epithelial lesion was more frequent in allergic rhinitis (94%) than in non-allergic rhinitis (65%) patients. In the presence of basement membrane thickness, as a marker of remodeling, there was no difference in the nasal lavage of patients with allergic rhinitis and non-allergic rhinitis.ConclusionIn this series, 4% was the cutoff point for the number of eosinophils in the nasal lavage, for atopy differentiation. Upper airway remodeling accessed by basement membrane thickness showed similar inflammatory cell infiltrate in the nasal lavage, regardless of the presence of atopy.     

Nasal polyps, bronchial asthma and aspirin sensitivity.

The ASA triad comprises bronchial asthma, acetylsalicylic acid (ASA) sensitivity and nasal polyps. It presents as chronic rhinitis followed by bronchial asthma and ASA sensitivity, and later nasal polyps. The pathogenesis of the ASA triad may involve interrelationships between disease in the upper and lower airway and hypersensitivity to cyclo-oxygenase inhibiting medications. Treatment of the nasal polyps has been shown to improve the patients' asthma.