Fluticasone propionate aqueous nasal spray in pregnancy rhinitis.

Pregnancy rhinitis is a common condition with longstanding nasal congestion; troublesome for the mother, possibly also affecting the fetus. There is need for a safe, effective treatment. Nasal corticosteroids, indisputable in other types of rhinitis, have not been evaluated in pregnancy rhinitis. In this placebo-controlled, randomized, double-blind study with parallel groups, we evaluated the effect of 8 weeks of treatment with fluticasone propionate aqueous nasal spray in 53 women with pregnancy rhinitis. Daily symptom scores and nasal peak expiratory flow, as well as acoustic rhinometry before and after treatment, did not show any difference between the groups. Placebo resulted in 6/27 responders, compared with 5/26 for active treatment. There was no detectable influence on maternal cortisol as measured by morning S-cortisol and overnight 12-h-U-cortisol, or any difference in ultrasound measures of fetal growth or pregnancy outcome. Altogether, our study indicates no significant effects of the treatment described here.     

Medical management of rhinitis in pregnancy

Medical treatment options for patients with rhinitis during pregnancy need careful considerations. It is important to distinguish between the causes of rhinitis, as this can influence treatment. Conservative options are important for patients with pregnancy-induced rhinitis (PIR) and pre-existing allergic or non-allergic rhinitis. Education and knowledge that PIR symptoms will resolve after pregnancy can offer some relief. Other strategies such as exercise, positioning, saline nasal douching/lavage, and nasal valve dilators are safe in pregnancy and can have a benefit in these patients with rhinitis of any aetiology. The main medical therapies usually used in rhinitis cannot always be directly translated to pregnant patients due to potential teratogenic effects. Topical corticosteroids have generally shown to be safe with budesonide having the strongest recommendations. Oral corticosteroids are mostly used in moderate-severe disease and should be avoided in the first trimester. Oral decongestants have associations with cardiac, ear, gut and limb abnormalities and are not recommended in the first trimester. Loratadine and cetirizine have been the most well-studied second-generation antihistamines and are generally considered safe. There has been no reported increased risk of teratogenicity with anticholinergics or cromones, with the latter being one of the first line options in pregnant women with allergic rhinitis. The role of allergen immunotherapy needs further research, but current guidance states it can be continued if already initiated prior to pregnancy. The management of rhinitis in pregnancy can therefore be complex. This review aims to evaluate the current medical management options for rhinitis in pregnancy.     

Nasal hyperreactivity to methacholine measured by acoustic rhinometry in asymptomatic allergic and perennial nonallergic rhinitis

This study was carried out to assess nasal response to different doses of methacholine and to evaluate the diagnostic possibilities of this test. Thirty-seven patients with allergic rhinitis induced by pollen (out of season), 16 with nonallergic rhinitis, and 25 normal subjects were evaluated. After provocation with saline, increasing doses of methacholine, ranging from 0.5 to 16 mg/mL, were applied. Nasal obstruction was assessed by acoustic rhinometry 10 minutes after each dose, the minimum cross-sectional area and the nasal volume in both fossae were obtained. Ipratropium bromide was applied after the last dose of methacholine to evaluate reversibility. After methacholine challenge with 0.5, 1, 2, and 4 mg/mL there was a statistically significant decrease (p < 0.05) in nasal area and volume in a dose-dependent manner in patients with allergic and nonallergic rhinitis in comparison with controls. A ROC (receiver-operating characteristic) analysis showed that a decrease in nasal volume > or = 20% at methacholine concentration of 2 mg/mL is able to predict the presence of rhinitis (positive predicted value 93%, negative predicted value 79%) in 75% of subjects. The clinical relevance of this finding suggests that patients with symptomatic nonallergic rhinitis or even asymptomatic patients with allergic rhinitis out of pollen season present a nasal hyperreactivity to methacholine, and that a decrease of nasal volume > 20% by acoustic rhinometry after challenge with methacholine at 2 mg/mL is able to discriminate these patients from normal subjects. This method seems to be a suitable tool in the diagnosis of rhinitis.     

Nasal hyperreactivity.

Nasal hyperreactivity is an important feature of allergic and non-allergic rhinitis. This paper reviews the possible mechanisms behind hyperreactivity. Distinct mechanisms may play a role in allergic rhinitis--an inflammatory disease--and non-allergic rhinitis, mainly a non-inflammatory disease. In allergic rhinitis, particularly in perennial allergic rhinitis, there is a close connection between allergic response and non-specific hyperreactivity. In non-allergic rhinitis, a pathological entity comprising a heterogeneous series of diseases, understanding and measuring nasal hyperreactivity is much more difficult. A variety of methods to assess nasal hyperreactivity are available. Given the heterogeneity of mechanisms, the various patients groups and the lack of standardization in tests, it is not surprising that measurement of nasal hyperreactivity is not included in the diagnostic arsenal of the clinician.     

Treatment of allergic rhinitis during pregnancy

BACKGROUND: Allergic rhinitis (AR) affecting approximately 20-30% of women in childbearing age can be considered one of the most common group of medical conditions that complicate pregnancy. AR with symptoms of nasal obstruction, sneezing, and itching may require pharmacotherapy. However, there are concerns regarding the safety of different available agents that can be used during pregnancy with respect to both maternal and fetal well being. CONCLUSIONS: The best first-line approach in the management of AR is avoidance of allergens. If environmental modification is ineffective, then the pharmacologic agents should be chosen. For symptoms of rhinorrhea, sneezing, or itching, intranasal cromolyn, with its excellent safety profile, should be considered as first-line therapy. If cromolyn is ineffective or poorly tolerated, first-generation (e.g., chlorpheniramine and tripelennamine) and second generation (e.g., cetirizine and loratadine) antihistamines can be given. Intranasal steroids (e.g., beclomethasone dipropionate, and budesonide) can be added to first-line therapy especially for severe nasal obstruction. There are no epidemiological studies with newer intranasal steroids (e.g., flunisolide, triamcinolone acetonide, fluticasone propionate, and mometasone furoate) during the first trimester of pregnancy. Immunotherapy has not proven to be teratogenic and is clinically useful in improving symptoms. Oral and topical decongestants can be considered as second-line therapy, for short-term relief, when no safer alternative is available.     

Fluticasone propionate aqueous nasal spray in pregnancy rhinitis

Pregnancy rhinitis is a common condition with longstanding nasal congestion; troublesome for the mother, possibly also affecting the fetus. There is need for a safe, effective treatment. Nasal corticosteroids, indisputable in other types of rhinitis, have not been evaluated in pregnancy rhinitis. In this placebo‐controlled, randomized, double‐blind study with parallel groups, we evaluated the effect of 8 weeks of treatment with fluticasone propionate aqueous nasal spray in 53 women with pregnancy rhinitis. Daily symptom scores and nasal peak expiratory flow, as well as acoustic rhinometry before and after treatment, did not show any difference between the groups. Placebo resulted in 6/27 responders, compared with 5/26 for active treatment. There was no detectable influence on maternal cortisol as measured by morning S‐cortisol and overnight 12‐h‐U‐cortisol, or any difference in ultrasound measures of fetal growth or pregnancy outcome. Altogether, our study indicates no significant effects of the treatment described here.     

基因重组γ干扰素在治疗变应性鼻炎中的作用

目的研究基因重组γ干扰素在治疗变应性鼻炎中的作用.方法采用随机对照研究方法将60例变应性鼻炎患者分成两组,每组30例,一组予常规脱敏治疗(对照组),另一组予常规脱敏治疗加基因重组γ干扰素治疗(实验组),6个月后比较两组的症状评分、血清白细胞介素-4(IL-4)、嗜酸粒细胞阳离子蛋白(ECP)水平.结果对照组治疗前、后症状评分分别为10.6±2.3和4.2±1.8,血清IL-4水平分别为(545.3±86.2)ng/L和(320.4±76.3)ng/L,ECP水平分别为(24.3±8.2)μg/L和(12.4±6.3)μg/L;实验组治疗前、后症状评分分别为10.8±2.7和3.5±1.6,血清IL-4水平分别为(547.8±84.6)ng/L和(280.4±87.3)ng/L,ECP水平分别为(25.1±7.7)μg/L和(10.4±5.1)μg/L.实验组治疗后症状评分、IL-4和ECP水平均低于对照组(均P<0.05).结论基因重组γ干扰素能改善变应性鼻炎症状,降低血清IL-4、ECP水平,在变应性鼻炎的治疗中发挥着免疫调节作用.     

Vestibular hyperreactivity and hyperventilation

In a group of 26 patients with a hyperventilation syndrome, 77% showed vestibular hyperreactivity of velocity step responses, mostly due to an increase in gain of the vestibulo-ocular reflex (VOR), apparent from an increase in initial velocity, but also due to an increase in the time constant. Similar effects were found among 11 normal subjects after forced hyperventilation. In another group of 44 patients whose primary complaint was dizziness and who showed vestibular hyperreactivity without having any other demonstrable abnormality, a hyperventilation syndrome was found in 75%. This suggests that the velocity step test without hyperventilation provocation is a useful test for the detection of a hyperventilation syndrome.     

Chronic rhinitis in children.

One hundred and fifty-one children aged 2-6 years old suffering from chronic rhinitis were followed and treated for periods of 3-6 months. Seventy-five children were treated with antihistamines (AH) and 76 with antibiotics (AB). Significant statistic difference was found between pre-school children and school children. The differences were both with the nature of the symptoms, and reaction to treatment. While 49% of the school children recovered with AH treatment, only 14% of the pre-school children did. On the other hand, 58% of the pre-school children recovered with AB treatment while only 35% of the older children did. From our results it is clear that in many children bacterial infection is the cause for chronic rhinitis. In pre-school children it is the main cause, while in older children it is the cause in about a third of the cases. It is also important to remember that although allergy might be the basic reason for rhinitis, in certain age groups a secondary bacterial infection might interfere with the efficiency of antiallergic treatment.     

变应性鼻炎患者外周血Th1/Th2型细胞因子表达意义及其对气道高反应性的预测价值研究

目的 分析变应性鼻炎(AR)患者外周血Th1/Th2型细胞因子表达意义及其对气道高反应性的预测价值。方法 选定海安市人民医院2020年1月—2022年1月接诊的50例AR患者,同期选取海安市人民医院门诊体检的50例健康体检者作为对照组,检测、比较两组血清Th1细胞因子[干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)]、Th2细胞因子[白细胞介素-5(IL-5)、白细胞介素-4(IL-4)],对比AR患者中轻度、中重度组血清Th1、Th2细胞因子;根据气道反应是否正常将AR患者分为两组,27例气道反应正常的患者设为气道反应正常组,23例气道高反应的患者设为气道反应异常组,比较两组血清Th1、Th2细胞因子,绘制受试者工作曲线(ROC),计算曲线下面积(AUC),分析血清Th1、Th2细胞因子对气道高反应的预测价值。结果 AR患者血清IFN-γ均低于对照组(P<0.05),AR患者血清TNF-α、IL-4、IL-5均高于对照组(P<0.05)。中重度AR患者血清IFN-γ均低于轻度组、对照组(P<0.05),中重度AR患者血清TNF-α、IL-4、IL-5均高于...     

Differentiation between allergic rhinitis and vasomotor rhinitis. Light and electron microscopic studies

The pathological changes of nasal mucosa from allergic rhinitis and vasomotor rhinitis were observed. The results showed that the general characteristic was vascular dilatation with increased permeability and glandular proliferation with increased secretory activity. The pathological difference between mucous membranes of allergic and vasomotor rhinitis were mainly cellular infiltration and degree of damage on vascular wall. In allergic rhinitis there were more eosinophils, basophils, neutrophils and some mast cells and plasma cells in nasal mucosa. Gap formation in capillary wall was found in allergic nasal mucosa, there were less cellular infiltration and no gap formation in vasomotor rhinitis.     

Fibre-optic endoscopy in atrophic rhinitis.

Primary atrophic rhinitis seems to have a high prevalence in the arid regions bordering the great deserts of Saudi-Arabia. Fibre-optic endoscopy was performed on 42 patients treated surgically. Fibre-optic endoscopy demonstrated the presence of crusts in the nasal cavities and their subsequent reduction following surgery. It also demonstrated ulceration of the cartilaginous nasal septum in some cases and this may explain the pathogenesis of septal perforation noted in a high number of our patients. Fibre-optic nasendoscopy was also helpful in demonstrating the reappearance of free mucus in the nasal cavity and helped to determine the optimal time for reversing Young's procedure. Fibre-optic nasendoscopy is a reliable tool for verifying the results of surgery and comparing the efficacy of various treatment modalities.     

妊娠期变应性鼻炎特异性免疫治疗的安全性研究

目的 探讨变应性鼻炎患者妊娠期进行变应原特异性免疫治疗(脱敏疗法)的安全性.方法 回顾性分析1998～2008年在妊娠期接受特异性免疫治疗的变应性鼻炎患者11例,包括治疗期间的药物使用情况、免疫治疗不良反应及处理、妊娠期常规体检指标、胎儿的生产方式、出生时体重、有无早产或畸形、出生后3个月时的健康状况等.结果 11例患者在妊娠期间均顺利完成免疫治疗,1例患者偶尔使用布地奈德鼻喷剂,2例患者因不良反应进行了剂量调整,所有患者妊娠期常规检查正常,9例孕妇行剖宫产,2例孕妇顺产,所有胎儿均无早产及畸形,随访3月健康状况均无异常.结论 目前观察结果显示,妊娠期变应性鼻炎特异性免疫治疗具有良好的安全性,但需要积累更多的病例资料.