scholarly journals Effect of Postoperative Specific Immunotherapy Combined with Nasal Irrigation on Chronic Rhinosinusitis with Allergic Rhinitis

2021 ◽  
Author(s):  
Jia Li ◽  
Houyong Kang ◽  
Suling Hong ◽  
Yang Shen
Keyword(s):  
Allergic Rhinitis ◽  
Chronic Rhinosinusitis ◽  
Eosinophil Cationic Protein ◽  
Sinus Surgery ◽  
Postoperative Treatment ◽  
Subcutaneous Immunotherapy ◽  
Expression Levels ◽  
Nasal Irrigation ◽  
Group A ◽  
One Year

Patients with chronic rhinosinusitis (CRS) and allergic rhinitis (AR) (CRSwAR) have a more severe condition with a higher rate of recurrence after endoscopic sinus surgery (ESS). This study aimed to explore the effect of specific subcutaneous immunotherapy (SCIT) and nasal irrigation on CRSwAR after ESS. Sixty-four patients who were diagnosed as CRSwAR and received ESS were enrolled and divided into groups A, B, and C to receive different postoperative treatment strategies (conventional medication, medication with nasal irrigation, and medication with nasal irrigation and SCIT), and their prognosis was evaluated by scoring, electron microscopy, and inflammatory factors. One year after ESS, the recurrence rate of group C was significantly reduced; and the scoring from baseline was significantly different among the three groups, which of group C were the best. The epithelium arrangement, cilia morphology, and inflammation of nasal mucosa in each group were better than those in the preoperative state; and those in group C were the best. After one year, the expression levels of eosinophil cationic protein (ECP), interleukin (IL)-8, and IL-17 in group B were lower than those of group A; and the expression levels of ECP, IL-8, IL-25, IL-33, IL-17 in group C were lower than those in group A. SCIT combined with nasal irrigation can improve the patients' symptoms and quality of life, promote the epithelialization of the mucosa in the surgical cavity, regulate the local immune response of the nasal cavity; thus improve the prognosis of patients with ESS after 1 year.

scholarly journals Expression of Matrix Metalloproteinases and Their Tissue Inhibitors in Chronic Rhinosinusitis With Nasal Polyps: Etiopathogenesis and Recurrence

2020 ◽  
pp. 014556131989663
Author(s):  
Germano Guerra ◽  
Domenico Testa ◽  
Francesco Antonio Salzano ◽  
Domenico Tafuri ◽  
Eleonora Hay ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Matrix Metalloproteinases ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Polymerase Chain Reaction Analysis ◽  
Sinus Surgery ◽  
Control Group ◽  
Nonallergic Rhinitis ◽  
Tissue Inhibitors ◽  
Immunologic Diseases

Chronic rhinosinusitis with nasal polyps is a multifactorial disease of the nasal and paranasal sinus mucosa and it includes, as comorbidities, anatomic and morphologic alterations, allergic rhinitis, and immunologic diseases. We investigated matrix metalloproteinases (MMP-2, MMP-7, and MMP-9) and their tissue inhibitors (TIMP-1 and TIMP-2) concentration in different etiopathogenetical groups of patients with nasal polyposis (NP) in relation to recurrence after sinonasal surgery. The study group consisted of 45 patients with NP (those with allergic rhinitis, nonallergic rhinitis and asthma or nonallergic rhinitis, and obstruction of osteomeatal complex [OMC]) who underwent endonasal sinus surgery. We also collected 10 patients who underwent septoplasty as control. Immunohistochemistry of nasal mucosa fragments, Western blotting, and polymerase chain reaction analysis showed increased MMPs levels (MMP-9 more than MMP-2 and MMP-7) and decreased tissue inhibitors of MMPs levels (TIMP-1 less than TIMP-2), in patients with chronic rhinosinusitis with nasal polyps compared with control group, in particular in patients with nonallergic rhinitis and asthma compared to those with allergic rhinitis and nonallergic rhinitis and obstruction of OMC. We observed a higher risk of recurrence in patients with nonallergic rhinitis and asthma than in those with allergic rhinitis and nonallergic rhinitis and obstruction of OMC after 36 months from surgery. In this research, we evaluated pathogenesis of NP related to MMPs and their inhibitors concentrations in polypoid tissue.

scholarly journals The Effectiveness of Budesonide Nasal Irrigation After Endoscopic Sinus Surgery in Chronic Rhinosinusitis With Asthma

2017 ◽  
Vol 10 (1) ◽  
pp. 91-96 ◽  
Author(s):  
Tae Wook Kang ◽  
Jae Ho Chung ◽  
Seok Hyun Cho ◽  
Seung Hwan Lee ◽  
Kyung Rae Kim ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Nasal Irrigation

scholarly journals Sustained impact of subcutaneous immunotherapy among patients with allergic rhinitis who experienced treatment delay due to the COVID-19 pandemic: A multicenter, two-arm, real-world study

2021 ◽  
Author(s):  
SUIZI ZHOU ◽  
Yibin Liu ◽  
Jianrong Xue ◽  
Juan Tang ◽  
Qingqing Yu ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Depression Scale ◽  
Treatment Delay ◽  
Psychological Status ◽  
Subcutaneous Immunotherapy ◽  
Self Rating ◽  
Medication Score ◽  
Delayed Group ◽  
One Year ◽  
The Impact

Background: The aim of this study is to investigate the impact of COVID-19 related treatment delay on subcutaneous immunotherapy (SCIT) efficacy in patients with allergic rhinitis (AR). Methods: The study was performed in 643 patients with SCIT appointments between February 1 and May 31, 2020. The clinical assessment, performed at baseline (V0) and one year later (V1), included visual analogue scale (VAS); daily symptom score (dSS); daily medication score (dMS); combined symptom and medication scores (CSMS); quality of life (QoL); self-rating anxiety scale (SAS); and self-rating depression scale (SDS) for each patient. Results: At V0, 249 patients were treated on schedule, and 394 were delayed (7 ± 4.68 weeks). Among them, 319 patients (105 on schedule, and 214 delayed) also completed the assessments at V1, with the absence of 25.39% patients due to completion of SCIT, and 25.35% patients were withdrawal. The results of all assessments were within the normal range for all patients at V0 and V1, with the exception of a slightly higher SDS score (56.13) at V0. In the SCIT delayed group. there was a significant positive correlation between the length (weeks) of the delay and SDS score, and this was significantly higher in patients with poor control of nasal symptoms. Conclusions: This study showed the long-term efficacy of SCIT for AR patients, including those who have had to delay normal therapy due to the COVID-19 outbreak. The psychological status of SCIT patients in response to lockdown of hospital services during this critical period should be considered.

scholarly journals Metabolomics Reveals Process of Allergic Rhinitis Patients with Single- and Double-Species Mite Subcutaneous Immunotherapy

Metabolites ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 613
Author(s):  
Peiyan Zheng ◽  
Guanyu Yan ◽  
Yida Zhang ◽  
Huimin Huang ◽  
Wenting Luo ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Arachidonic Acid ◽  
Allergic Diseases ◽  
Subcutaneous Immunotherapy ◽  
Therapeutic Effects ◽  
Life Questionnaire ◽  
Potential Biomarker ◽  
Significant Difference ◽  
Acid Pathway ◽  
One Year

Allergen immunotherapy (AIT) is the only treatment that can change the course of allergic diseases. However, there has not been any research on metabolic reactions in relation to AIT with single or mixed allergens. In this study, patients with allergic rhinitis caused by Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farinae (Der f) were treated with single-mite (Der p) and double-mite (Der p:Der f = 1:1) subcutaneous immunotherapy (SCIT), respectively. To compare the efficacy and the dynamic changes of inflammation-related single- and double-species mite subcutaneous immunotherapy (SM-SCIT and DM-SCIT), we performed visual analogue scale (VAS) score, rhinoconjunctivitis quality of life questionnaire (RQLQ) score and serum metabolomics in allergic rhinitis patients during SCIT. VAS and RQLQ score showed no significant difference in efficacy between the two treatments. A total of 57 metabolites were identified, among which downstream metabolites (5(S)-HETE (Hydroxyeicosatetraenoic acid), 8(S)-HETE, 11(S)-HETE, 15(S)-HETE and 11-hydro TXB2) in the ω-6-related arachidonic acid and linoleic acid pathway showed significant differences after approximately one year of treatment in SM-SCIT or DM-SCIT, and the changes of the above serum metabolic components were correlated with the magnitude of RQLQ improvement, respectively. Notably, 11(S)-HETE decreased more with SM-SCIT, and thus it could be used as a potential biomarker to distinguish the two treatment schemes. Both SM-SCIT and DM-SCIT have therapeutic effects on patients with allergic rhinitis, but there is no significant difference in efficacy between them. The reduction of inflammation-related metabolites proved the therapeutic effect, and potential biomarkers (arachidonic acid and its downstream metabolites) may distinguish the options of SCIT.

scholarly journals A comparative study to evaluate the effects of intranasal steroid spray, isotonic saline nasal irrigation and combination therapy in patients with allergic rhinitis

2021 ◽  
Vol 7 (6) ◽  
pp. 1004
Author(s):  
Smitha Soubhagya Gangaraju ◽  
Nikitha Pillai ◽  
Vijaylaxmi Manthal
Keyword(s):  
Allergic Rhinitis ◽  
Combination Therapy ◽  
Isotonic Saline ◽  
Treatment Modalities ◽  
Nasal Irrigation ◽  
Intranasal Corticosteroids ◽  
Nasal Symptoms ◽  
Before And After ◽  
Group A ◽  
Group B

<p class="abstract"><strong>Background:</strong> Allergic rhinitis (AR) is characterized by inflammatory changes in the nasal mucosa caused by exposure to inhaled allergens. AR clinically having 2 or more symptoms of anterior or posterior rhinorrhea, sneezing, nasal blockage or itching of the nose during two or more consecutive days for more than 1 hour on most days which are caused by allergen exposure leading to an IgE mediated reaction. Nasal steroids and antihistamines are considered as gold standard treatment of choice in moderate to severe AR. This study was taken to evaluate the efficacy of intranasal steroid spray, isotonic saline nasal irrigation, combination therapy and to compare all 3 treatment modalities.</p><p class="abstract"><strong>Methods:</strong> 75 patients of AR who met inclusion criteria were sequentially divided into 3 groups. Group A was intranasal steroid spray, group B was isotonic saline nasal irrigation, group C was combination of both intranasal steroid spray and saline nasal irrigation. Total nasal symptoms score was compared before and after 1 month of treatment.</p><p class="abstract"><strong>Results:</strong> Mean total nasal symptoms score before treatment in groups A, B and C was found to be 13.72, 12.96 and 13.68 respectively and after 1 month of treatment total nasal symptoms score was seen 8.28, 8.76 and 3.72 respectively.</p><p class="abstract"><strong>Conclusions:</strong> The combined use of saline nasal irrigation along with intranasal corticosteroids is found to be more effective in reducing the symptoms of patients with allergic rhinitis when compared to individual therapies.</p>

Budesonide vs Saline Nasal Irrigation in Allergic Rhinitis: A Randomized Placebo-Controlled Trial

2020 ◽  
Vol 162 (6) ◽  
pp. 979-984
Author(s):  
Nikitha Periasamy ◽  
Kailesh Pujary ◽  
Ajay M. Bhandarkar ◽  
Naveen D. Bhandarkar ◽  
Balakrishnan Ramaswamy
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Response ◽  
Hypertonic Saline ◽  
Controlled Trial ◽  
Tertiary Care ◽  
Sinus Surgery ◽  
Care Hospital ◽  
Double Blind ◽  
Nasal Irrigation ◽  
Snot 22

Objectives Budesonide nasal irrigation is currently widely used in the treatment of chronic sinusitis typically following endoscopic sinus surgery to improve inflammatory control. Its application in treatment of allergic rhinitis has not been previously studied. This study assesses the subjective and clinical response to budesonide buffered hypertonic saline nasal irrigation and hypertonic saline nasal irrigation in patients with allergic rhinitis. Study Design This is a prospective, single-center, double-blind, randomized placebo-controlled trial. Setting Tertiary care hospital. Subjects and Methods Fifty-two patients diagnosed with allergic rhinitis were randomized into 2 groups to receive either buffered hypertonic saline nasal irrigation with a placebo respule or buffered hypertonic saline nasal irrigation with a budesonide respule. Patients were assessed at baseline and 4 weeks subjectively using the Sino-Nasal Outcome Test–22 (SNOT-22) questionnaire and visual analog scale (VAS). Clinical assessment was done using the modified Lund-Kennedy score. Results The average SNOT-22, VAS, and modified Lund-Kennedy scores improved in both groups ( P < .001). The budesonide irrigation group was found to have significantly better improvement than the saline nasal irrigation group with the SNOT-22 scores ( P = .012) and VAS scores ( P = .007). However, the difference in the clinical response between the 2 groups was not significant ( P = .268). Conclusion This study adds evidence to the use of saline nasal irrigation in allergic rhinitis but also demonstrates efficacy of the addition of budesonide to irrigations. Budesonide nasal irrigation thus appears to be a viable treatment option for allergic rhinitis.

Analysis of Histopathological Endotyping for Chronic Rhinosinusitis Phenotypes Based on Comorbid Asthma and Allergic Rhinitis

2019 ◽  
Vol 33 (5) ◽  
pp. 507-512 ◽  
Author(s):  
Jeffrey P. Radabaugh ◽  
Joseph K. Han ◽  
Rachel G. Moebus ◽  
Evan Somers ◽  
Kent Lam
Keyword(s):  
Allergic Rhinitis ◽  
Chronic Rhinosinusitis ◽  
Plasma Cells ◽  
Inverse Correlation ◽  
Cell Types ◽  
Sinus Surgery ◽  
Controlled Study ◽  
Histopathological Analysis ◽  
Tissue Samples ◽  
Direct Management

Background An emerging trend in clinical research has centered on improving the characteristics of chronic rhinosinusitis (CRS) according to phenotypes and endotypes. The objective of this study is to utilize histopathological markers to better characterize CRS phenotypes that are defined by the presence or absence of comorbid bronchial asthma (BA) and allergic rhinitis (AR). Methods A prospective case-controlled study of CRS patients was conducted. For the CRS cohort, mucosal biopsies were obtained during endoscopic sinus surgery, while samples of ethmoid mucosa were collected in control patients undergoing endoscopic skull base surgery. Histopathological analysis of tissue samples determined the relative frequency of inflammatory cell types, including eosinophils, lymphocytes, neutrophils, mast cells, and plasma cells. The presence and absence of comorbid BA and AR were used to further divide CRS, allowing for further subgroup analysis. Results Of 82 recruited patients, there were 67 CRS patients and 15 controls. Significantly increased eosinophil ratios were found in CRS patients with AR, BA, or both, when compared with controls ( P < .001). Conversely, CRS patients with neither comorbid diagnosis failed to demonstrate statistically significant elevations in eosinophil ratios ( P > .05). Lymphocyte ratios showed a significantly inverse correlation with trends demonstrated by eosinophil ratios in all patient subgroups ( P < .001). Neutrophil, mast cell, and plasma cell ratios did not show significant differences across the evaluated subgroups. Conclusions The clinical diagnosis of comorbid BA and AR may aid in better characterizing CRS endotypes without invasive testing and better direct management of the disease.

Therapeutic indications for sinonasal topical steroid treatment and its effects on eosinophilic chronic rhinosinusitis after endoscopic sinus surgery

2021 ◽  
pp. 1-6
Author(s):  
T Saito ◽  
K Okazaki ◽  
Y Hamada ◽  
K Hashimoto ◽  
K Tsuzuki
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Topical Steroid ◽  
Steroid Treatment ◽  
Sinus Surgery ◽  
Olfactory Loss ◽  
Eosinophilic Chronic Rhinosinusitis ◽  
Group A ◽  
Operative Indications ◽  
Group B

Abstract Objective This study evaluated the post-operative indications for sinonasal topical steroid treatment using a corticosteroid (steroid)-eluting, sinus-bioabsorbable device and its effects in patients with eosinophilic chronic rhinosinusitis. Method Post-operative courses were investigated in two groups: group A with patients who underwent sinonasal topical steroid treatment, and group B with control patients who did not. Results Group A was significantly younger than group B (p < 0.01), and the pre-operative computed tomography score was significantly higher in group A than in group B (p < 0.05). In the post-operative stage, the nasal symptoms questionnaire component of olfactory loss and the post-operative endoscopic appearance score were significantly worse in group A than in group B (p < 0.01). Conclusion These data suggest that younger age, more severe rhinosinusitis and post-operative olfactory loss led to the need for sinonasal topical steroid treatment to prevent relapsing inflammation after functional endoscopic sinus surgery in patients with eosinophilic chronic rhinosinusitis.

Is Respiratory Epithelial Adenomatoid Hamartoma Related to Central Compartment Atopic Disease?

2020 ◽  
Vol 34 (5) ◽  
pp. 610-617 ◽  
Author(s):  
Joseph S. Schertzer ◽  
Joshua M. Levy ◽  
Sarah K. Wise ◽  
Kelly R. Magliocca ◽  
John M. DelGaudio
Keyword(s):  
Allergic Rhinitis ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Benign Lesion ◽  
Retrospective Chart Review ◽  
Central Compartment ◽  
Atopic Disease ◽  
Sinus Surgery ◽  
Respiratory Epithelial Adenomatoid Hamartoma ◽  
Respiratory Epithelial

Background Respiratory epithelial adenomatoid hamartoma (REAH) is a benign lesion of the sinonasal tract that may mimic more concerning pathology. Clinical factors associated with REAH have not been well characterized. Objective To report our findings on patients with this pathologic diagnosis. Methods A retrospective chart review of patients with REAH between September 2006 and November 2019 was conducted. Data collected included clinical allergic rhinitis and asthma history, additional sinonasal diagnoses, prior sinus surgery, and the location of the REAH within the sinonasal cavity. Results Twenty-six patients were identified (53.8% male, mean age 62 years [range, 29–93]). Bilateral REAH occurred in 50%. REAH was located at the superior nasal septum in 84.6% cases, with the remainder identified in sinus contents submitted for pathology, making definitive site uncertain. Concurrent sinonasal inflammatory disorders were identified in 18 patients (69.2%), including chronic rhinosinusitis with nasal polyps—not otherwise specified (6), chronic rhinosinusitis without nasal polyps (4), aspirin-exacerbated respiratory disease (2), allergic fungal rhinosinusitis (1), central compartment atopic disease (5), and IgG4-related sclerosing disease (1). Eight patients had isolated REAH. Adequate allergy records were available for 19 patients, of which 18 of 19 (94.7%) had clinical allergic rhinitis. Conclusions REAH is a benign sinonasal lesion commonly located within the central compartment of the nasal cavity, a site of significant allergen exposure. Affected patients have a high incidence of allergy along with chronic inflammatory conditions. The coexistence of REAH within inflammatory nasal mucosa in a consistent anatomic location, suggests REAH may have a similar etiology to central compartment atopic disease, with resultant respiratory glandular ingrowth within long-standing reactive changes of mucosa derived from ethmoid embryologic origin.

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