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)     

过敏性鼻炎独生子女患者的心理人格研究

目的　了解过敏性鼻炎（AR）对独生子女人格的影响。方法　应用明尼苏达多相个性调查表（Minnesota Multiphasic Personality Inventory,MMPI）调查分析独生子女AR患者35例,并与非独生子女AR患者49例对照,患者均为中重度持续性AR。结果　独生子女患者的效度量表中的诈病量表（Infrequency,F）和临床量表中的疑病量 表（Hypochondriasis,Hs）、抑郁量表（Depression,D）、性度量表（Masculinity,Mf）、轻躁狂量表（Hypomania,Ma）4个临床量表T分（t 分别为2.169、1.955、2.009、2.546、2.012,P 均＜0.05）明显高于非独生子女患者,附加量表中的依赖性量表（Dependency,Dy）T分非常显著的高于非独生子女患者（t =2.66,P＜0.01）。中重度持续性AR男女患者间各量表得分无明显差异。结论　与非独生子女AR患者相比,独生子女AR患者的人格心理特征倾向于更关心和专注于自己的健康问题、更不愉快和易于绝望、更易怒和暴躁、更感孤独和希望独处等以外、更倾向于易夸大病情、更依赖他人和对传统性别角色责任的不认同。提示独生子女AR患者的心理功能更差,临床医师应该给予更多关注。     

Screening of allergic rhinitis

The author, in an attempt to define the most suitable means for the preclinical diagnosis of allergic rhinopathy, submitted 1620 pupils from seven different state schools to examination. Their parents were asked to fill in a questionnaire through which 370 were considered to be "at risk". All children underwent scratch skin tests: 73 with positive skin reactions also underwent nasal examination, measurement of immunoglobulins in nasal secretion, rhinomanometry, nasal exposition tests, determination of blocking antibodies and radiological examination of the paranasal sinuses. RAST was carried out in 30 cases. After the analysis of the clinical data, the author came to the conclusion that the tests of nasal conductance and provocation, of mucociliary clearance and determination of blocking antibodies are adequate means for the long term study of allergic rhinitis and for the follow-up of contingent hyposensitization therapy. As far as the preclinical diagnosis is concerned the skin tests and the radiological examination of the paranasal sinuses are to be considered more specific than RAST which, in the population sample taken into consideration, was positive exclusively in those cases that already had a manifest symptom complex.     

变应性鼻炎相关心理学研究

变应性鼻炎是耳鼻咽喉科常见的疾病之一,也是目前最常见的呼吸道慢性疾病之一,其反复发作及不适的鼻部症状给患者带来极大的经济及心理压力,严重影响患者的生活质量及心理健康。现代医学认为变应性鼻炎是常见十五种心身疾病之一,可导致多种精神及心理紊乱,如抑郁、焦虑、睡眠障碍、注意力障碍等,甚至可能是自杀的危险因素之一。然而变应性鼻炎的治疗原则中尚无心理相关的诊断及治疗。本文就变应性鼻炎与精神心理相关的国内外最新研究进展及心理干预治疗的必要性做一综述。     

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。     

变应性鼻炎和非变应性鼻炎炎症特征比较研究

目的探讨变应性鼻炎(allergic rhinitis,AR)和非变应性鼻炎(nonallergic rhinitis,NAR)炎症特征的差异。方法 2010年6月～2011年6月初次在我院耳鼻咽喉科就诊的AR患者101例、NAR患者117例及健康对照组162例,检验血液、鼻灌洗、诱导痰中EOS计数,并应用鼻激发和支气管激发试验等炎症相关的指标评价和分析AR和NAR的炎性特征的差异。结果 AR组鼻灌洗EOS计数、血清EOS比例、诱导痰EOS比例均显著高于NAR组(P<0.0 5)和对照组(P<0.0 5);而NAR组鼻灌洗EOS计数、血清EOS比例、诱导痰EOS比例也显著高于对照组(P<0.0 5)。AR组鼻激发阳性率为7 5.2%,高于NAR组(6 5.8%),但两者比较差异无统计学意义(χ2=2.3 1,P>0.0 5);而AR组、NAR组与对照组(32.1%)比较,差异具有统计学意义(χ2分别为46.36、31.06,P<0.01)。AR组支气管激发阳性率为14.9%,高于NAR组(10.3%),但两者比较差异无统计学意义(χ2=1.0 6,P>0.0 5);而AR组、NAR组与对照组比较,差异具有统计学意义(χ2分别为19.08、11.60,P<0.01)。结论AR和NAR患者鼻、下气道和全身均存在EOS炎症和气道高反应性,但AR组高于NAR组。临床中在关注AR患者与NAR患者的上气道炎症状况的同时,应重视下气道及全身炎症状况。     

Cryosurgery in allergic rhinitis

Nasal allergy is a common problem difficult to treat. Most of the chronic patients feel frustration even after completing all conventional modalities of treatment. We have used cryosurgery as an alternative mode of treatment for providing the permanent relief with regards to this disease. Cryosurgery basically freezes and debulks the hypertrophied inferior turbinates as well as the destroys the autonomic innervation, by a cryoprobe at 90°C. This study comprises 104 patients of Allergic Rhinitis. The patients were followed up for an average period of 3–6 months and the response was evaluated in term of relief in three basic clinical presentation namely Rhinorrhoea, Nasal-obstruction and Sneezing. Complete cure was obtained in 40.4% cases, Moderate (significant improvement in two of the features) in 30.87% cases and satisfactory results in 19.27% cases were observed. Only 9.67% cases showed no sign of improvement. This results infer that cryosurgery may be prescribed as an effective method of treatment in patients of Chronic Allergic Rhinitis.     

Pharmacotherapy for allergic rhinitis

Allergic rhinitis affects millions of Americans and the numbers continue to increase. Fortunately, there exists a wide array of pharmacotherapeutic options with relatively safe side effect profiles for the management of the varying subtypes. Additionally, there are newer agents on the horizon. The efficacies of intranasal corticosteroids, antihistamines, combination topical therapy, leukotriene inhibitors, mast cell stabilizers, anticholinergics, mucolytics, decongestants, and anti-IgE are reviewed.     

Antihistamines in allergic rhinitis

Antihistamines are the first line of pharmacotherapy in allergic diseases, especially in allergic rhinitis. The article also presents the interesting 2005-2007 publications on the use of antihistamine in practical point of view, especially the newly introduced ones (desloratadine, fexofenadine, levocetirizine) and those which are to be introduced soon (rupatadine). The efficacy in skin histamine provocation model and various clinical model were discussed.     

Probiotics in allergic rhinitis

Probiotics are live microorganisms used as supplementary food, usually lactic acid bacteria that can change either the composition and/or the metabolic activities of the gut microbiota modulating the immune system in a way that benefits the person's health.Aim: to review the use of Probiotics (Lactobacillus and Bifidobacterium) in allergic rhinitis patients.Materials and Methods: Pubmed original articles were used as data source.Results: results indicate that probiotics, Lactobacillus and Bifidobacterium appear to prevent allergy recurrences, alleviate the severity of symptoms and improve the quality of life of patients with allergic rhinitis. This happens because of the immune system modulation through the induction of cytokine production which cause a dominant TH1 response in allergic patients by modulating the TH1/TH2 balance effect.Conclusion: The use of probiotic bacteria could be an effective and safe way to prevent and/or treat allergic rhinitis, but its underlying mechanisms remain unclear. Therefore, clinical studies using probiotics and dietary intervention should be the focus of future research to enable a more widespread use.     

Endothelin-1 in nasal lavage fluid of allergic rhinitis patients--new mediator of allergic rhinitis

The nasal epithelium is considered to play an active role in the allergic inflammation through its capacity to synthesize and release a wide range of cytokines and mediators. Few studies have investigated the involvement of endothelin-1 in the pathogenesis of inflammatory diseases of the upper airways. To examine the release of endothelin-1 from nasal mucosa after allergen challenge we investigated 24 patients. 15 subjects (7 male, 8 female) allergic to birch pollen aged 37.1 +/- 4.9 years participated in the study. Nasal birch allergen provocation with following lavage was performed in all subjects. Endothelin-1 in the nasal secretion were assayed before and after challenge. Increase in concentration of endothelin-1 in nasal lavage fluid from allergic patients were significantly higher than in control group respectively from 18.33 +/- 5.47 fmol/ml to 26.41 +/- 6.92 fmol/ml versus 18.8 +/- 3.99 to 19.80 +/- 4.18 fmol/ml (p < 0.05) in controls. We conclude that endothelin-1 could be involved in the pathogenesis of seasonal allergic rhinitis.