Airway Nitric Oxide in Children with HDM-Induced Allergic Rhinitis

Background Rhinitis is a common problem in children. Airway nitric oxide (NO) was proposed to represent eosinophilic inflammation. Objectives To evaluate airway NO level in children with house dust mite (HDM)-induced allergic rhinitis Methods Children aged 5 to 18 years old with moderate–severe persistent rhinitis and positive result for the HDM nasal provocation test (NPT) was enrolled. The nasal symptoms evaluated by total nasal symptom score (TNSS) and visual analog scale (VAS) were recorded. Skin prick test (SPT) to common aeroallergens, fractional exhaled nitric oxide (FeNO), nasal nitric oxide (nNO), and blood test for specific IgE (sIgE) to HDM was measured. Rhinitis severity was categorized as severe if the VAS score > 7. Results Forty-eight children with HDM-induced allergic rhinitis with the mean age of 9.3 ± 2.4 years were enrolled. nNO levels and VAS score were significantly correlated (R = 0.398, P = .005). Children with severe rhinitis had significantly higher nNO levels than moderate rhinitis (1652.05 vs 941.30 parts per billion [ppb], P = .002), while there was no difference in FeNO level. ROC curve analysis demonstrated the cut-off value of nNO at 1350 ppb (AUC 0.764, 95% CI: 0.616-0.911, P = .002) for detecting severe HDM-induced allergic rhinitis with the sensitivity of 78% and the specificity of 71%. The level of FeNO in children who had HDM mean wheal diameter (MWD) > 8 mm was significantly higher than those with HDM MWD of 3 to 8 mm and those with a negative test (39.7 vs 14.3 vs 14.4 ppb; P = .006, respectively). Children who had sIgE to HDM < 0.35 KUA/L had significantly lower FeNO than those with sIgE to HDM 0.35 to 50 KUA/L and >50 KUA/L (9.5 vs 19.7 vs 40.4 ppb; P = .029, respectively). Conclusions Cut-off value for the diagnosis of severe HDM-induced chronic rhinitis was proposed. Rhinitis children who had a higher degree of HDM sensitization had a higher level of FeNO.

Sergančiųjų alerginiu rinitu gyvenimo kokybės ir klinikinių simptomų pokytis taikant intranazalinę fototerapiją

Žinoma, kad fototerapija teigiamai veikia imuninius procesus gleivinėje. Yra duomenų, kad intranazalinė fototerapija (IF), skleidžianti UV-A (25 proc.), UV-B (5 proc.) ir regimąją šviesą (70 proc.), gali būti veiksminga gydant alerginį rinitą (AR) nepriklausomai nuo simptomus sukėlusio alergeno, taip pat gali būti taikoma ieškant alternatyvų medikamentiniam gydymui. Tyrimo tikslas. Įvertinti intranazalinės fototerapijos poveikį klinikiniams alerginio rinito simptomams ir gyvenimo kokybei pacientų, sergančių nuolatiniu AR. Tyrimo metodai. Tyrimas atliktas Lietuvos sveikatosmokslų universiteto ligoninės Kauno klinikų Imunologijos ir alergologijos klinikoje. Jame dalyvavo sergantieji nuolatiniu vidutinio sunkumo arba sunkiu AR (ARIA diagnostiniai kriterijai). Alerginis įsijautrinimas patvirtintas odos dūrio mėginiais ir (arba) specifinio imunoglobulino E (Ig E) antikūnų įkvėpiamiems alergenams nustatymu kraujo serume. IF procedūros kartotos tris kartus per savaitę, dviejų savaičių laikotarpiu didinant dozę. Standartinis AR gydymas tyrimo metu nebuvo tęstas. Prieš ir po IF gydymo gyvenimo kokybė vertinta pagal E. Juniper adaptuotą klausimyną (angl. the Rhinoconjunctivitis Quality of Life Questionnaire, standardized version, RQLQ(s)), įvertintas bendrasis nosies simptomų balas (angl. Total Nasal Symptom Score, TNSS). Kiekvienos procedūros metu, naudojant vizualinę atitikmens skalę (angl. Visual Analogue Scale, VAS), įvertintas AR klinikinių simptomų sunkumas. Tyrimo rezultatai. 73 proc. tiriamųjų IF poveikį įvertino teigiamai. Nustatyta, kad po IF gydymo pagerėjo tiriamųjų gyvenimo kokybė, nes statistiškai reikšmingai sumažėjo Klausimyno (RQLQ(s)) visų poskalių balai. Po gydymo statistiškai reikšmingai sumažėjo visi TNSS skalės balai: nosies užgulimas, rinorėja, čiaudulys, miego sutrikimai, bendrieji simptomai. VAS skalės balai po gydymo taip pat sumažėjo statistiškai reikšmingai. Išvados. Intranazinė fototerapija gali palengvinti AR simptomus ir pagerinti pacientų gyvenimo kokybę.

Bisphenol A as a risk factor for allergic rhinitis in children

Aim: Bisphenol-A (BPA) is an endocrine disrupting compound and may exacerbate or induce allergic diseases. To the best of our knowledge, there is little evidence regarding the effects of BPA exposure on allergic rhinitis (AR) in children. In the present study, we sought to examine whether exposure to BPA in children is associated with AR. Methods: This study was designed as a case controlled clinical study. 140 children diagnosed as allergic rhinitis and 140 healthy children as control group were recruited. BPA, interleukin-4, interleukin-13, total IgE and interferon-gamma levels were determined. Skin prick tests were performed in patient group. Total nasal symptom score and ARIA classification were used to predict disease severity. Results: Serum IL-4, IgE and BPA levels of children with allergic rhinitis were found to be significantly higher than the control group. BPA and IL-4 levels were significantly higher in moderate to severe-persistent group. There was a positive correlation between total nasal symptom scores and Bisphenol A levels in children with allergic rhinitis. Conclusions: The present study is the first to observe statistically significant relationship between BPA concentrations and allergic rhinitis in children. Also increased levels of BPA are associated with disease severity.

Comparison of Outcomes Between Mometasone Furoate Intranasal Spray and Oral Montelukast in Patients with Allergic Rhinitis

Background: Allergic rhinitis is a common ailment with rising trend and worldwide prevalence of some 400 million. Methods: This prospective randomized crosssectional study was done at the Department of Otorhinolaryngology and Head and Neck Surgery, Tribhuvan University, Teaching Hospital, Kathmandu, Nepal from June 2016 to August 2017. They were randomly assigned to two groups by lottery method. Group A received mometasone furoate intranasal spray and Group B received oral montelukast for a total duration of one month. Prior to starting medication and one month after medications, total nasal symptom score was documented. Statistical analysis was done using SPSS version 18.Results: Total of 126 patients between 16 to 52 years were enrolled in the study. The mean duration of symptoms was 3.93 years. The mean value of serum total IgE was 833.49 IU/ml. The mean pre and post medication score for mometasone furoate intranasal spray group was 16.32 and 5.44 respectively, which was significant. Similarly, the mean pre and post medication score for oral montelukast group was 15.24 and 7.87 respectively which was also found to be significant. Comparing the means of scores for both the groups, mometasone furoate was found to be more effective than oral montelukast.Conclusions: Both mometasone furoate intranasal spray and oral montelukast were effective in the treatment of patient with allergic rhinitis. Oral montelukast can therefore be used as a first line treatment for patients with allergic rhinitis. Keywords: Allergic rhinitis; mometasone furoate intranasal spray; montelukast; serum total IgE; total nasal symptom score.

Clinical Study on Acupuncture Treatment of Perennial Allergic Rhinitis (PAR) Based on Zelen’s Design

Objective: Perennial allergic rhinitis (PAR) is clinically defined as an inflammatory condition of the nose characterised by nasal obstruction, sneezing, itching, or rhinorrhea, occurring for an hour or more on most days throughout the year. The study aimed to evaluate the effectiveness of acupuncture treatment for PAR. Methods: 76 subjects were enrolled with inclusion criteria and randomly divided into the acupuncture group (AG) and drug group (DG) based on Zelen’s design. In AG, Yintang (EX-HN3), LI20 (bilateral), LI11 (left), LI4 (left), ST36 (bilateral) were selected as primary acupoints, and adjunct acupoints were added based on syndrome differentiation. Acupuncture treatment for four weeks was performed once every two days. In DG, Desloratadine Citrate Disodium tablet was administrated orally once every day for four weeks. The variations of total nasal symptom score (TNSS) and overall non-nasal symptom score (TNNSS) were tested within three days before, at Week-4 during, and at Week-4 (follow-up) after the treatment. Results: Thirty-two subjects in the AG and 38 subjects in the DG completed the trial. The differences between TNSS and TNNSS scales in the same groups showed a statistical difference (P<0.05) before, during, and after the treatment. The statistic differences between TNSS and TNNSS in those two groups were not obtained (P＞0.05) before and after the treatment. The differences in those two groups during the follow-up visit were statistically different (P<0.05). Conclusion: Acupuncture could effectively control the nasal and systemic symptoms of PAR, and its effect was more persistent than the administration of Desloratadine Citrate Disodium.

Injection of Steroid in Nasal Polyps: A Systematic Review

Background Chronic rhinosinusitis (CRS) is a common chronic condition classically divided into two phenotypes according to the presence or absence of nasal polyps. The effects of both medical and surgical treatment are often temporary, encouraging research into new treatment options. Methods We performed a systematic review related to dosages, effects, side effects, and safety of intrapolyp steroid injection in patients with nasal polyps. We identified five studies with a total of 386 patients and 2490 intrapolyp steroid injections. Results Treatment with intrapolyp steroid injection leads to a decrease in the Total Nasal Polyps Score (TNPS), Total Nasal Symptom Score (TNSS), and Lund-Mackay Score. The dosage regimens vary from 10 to 40 mg triamcinolone acetonide. Only two cases of temporary visual complications were reported. Conclusion This review found that intrapolyp steroid injection may be an effective and safe treatment for patients with nasal polyps. However, there exist no large, randomized, clinical trials. We found no association between dose and effect, or dose and the risk of visual complications.

Pengaruh pemberian vitamin E terhadap eosinofil mukosa hidung dan kualitas hidup penderita rinitis alergi

Latar belakang: Penyakit rinitis alergi (RA) banyak dijumpai dan memberi dampak negatif terhadap produktivitas, kualitas hidup, gangguan tidur, aktivitas di luar rumah, serta gangguan sekolah pada anak. Vitamin E bekerja sebagai antioksidan pada membran sel dan berikatan dengan radikal bebas dengan cara menghambat peroksidasi Poly Unsaturated Fatty Acid (PUFA). Tujuan: Mengetahui pengaruh vitamin E terhadap jumlah eosinofil mukosa hidung dan perbaikan klinis pada penderita rinitis alergi persisten sedang berat. Metode: Menggunakan Randomized Clinical Trial, double blind, pre and post control group dengan perlakuan pemberian terapi semprot hidung triamcinolone acetonide, cetirizine 10 mg, dan vitamin E 400IU selama 4 minggu. Dilakukan penilaian Visual Analogue Scale (VAS) dan Total Nasal Symptom Score (TNSS), serta pemeriksaan eosinofil mukosa hidung pada awal dan 4 minggu setelah perlakuan. Hasil: Didapatkan perbedaan bermakna antara jumlah eosinofil mukosa hidung sebelum dan sesudah pemberian vitamin E pada kelompok perlakuan (p=<0,001). Penurunan jumlah eosinofil mukosa hidung lebih besar dan bermakna pada kelompok perlakuan dibandingkan dengan kelompok kontrol (p=<0,001). Didapat perbaikan kualitas hidup berdasarkan perbaikan nilai VAS dan TNSS yang bermakna setelah perlakuan pada kelompok kontrol maupun perlakuan (p=<0,001), serta didapatkan perbaikan kualitas hidup berdasarkan nilai VAS dan TNSS pada kedua kelompok dengan selisih nilai perbaikan gejala yang lebih besar pada kelompok perlakuan, namun dari perhitungan statistik tidak didapatkan perbedaan yang bermakna. Kesimpulan: Vitamin E 400IU menurunkan jumlah eosinofil mukosa hidung secara bermakna pada pasien rinitis alergi persisten sedang berat. Perbaikan nilai TNSS pada penggunaan vitamin E 400IU lebih baik dibandingkan subjek yang mendapat plasebo, walaupun tidak berbeda secara bermakna.Kata kunci: rinitis alergi, Vitamin E, Total Nasal Symptom Score ABSTRACT Background: Allergic rhinitis (AR) is an allergic disease frequently found and has a negative impact on productivity, quality of life, sleep disorder, outdoors activities, and school disruption in children. Vitamin E works as an antioxidant in cell membranes through binding free radicals by inhibiting peroxidation of Poly Unsaturated Fatty Acids (PUFA). Purpose: To find out the effect of vitamin E administration on nasal mucosa eosinophil counts and the clinical improvement in patients with moderate severe persistent AR. Methods: A double blind randomized clinical trial, pre and post control group, given therapy of triamcinolone acetonide nasal spray, cetirizine 10 mg, and vitamin E 400 IU orally for 4 weeks. Evaluation by Visual Analogue Scale (VAS) and Total Nasal Symptom Score (TNSS), as well as nasal mucosal eosinophils count at baseline and 4 weeks after treatment. Results: There was a significant difference on the number of nasal mucosal eosinophils before and after vitamin E administration in the treatment group (p = <0.001). A greater and more significant decrease in the number of nasal mucosal eosinophils in the treatment group compared to control group (p = <0.001). Significant improvement of VAS and TNSS after treatment in the control and treatment groups (p = <0.001) and quality of life improvement based on VAS and TNSS values in both control and treatment groups, but the statistical calculations showed no significant differences between the two groups. Conclusion: Vitamin E 400IU significantly reduce the number of nasal mucosal eosinophils in patients with moderate severe persistent AR.

Investigation of the effectiveness of the drug «Glenspray active» in patients with allergic rhinitis

Relevance: Over the past decade, an increase in the number of patients with AR has been noted. According to epidemiological studies conducted in different countries, the prevalence of AR is from 1 to 40%. In most European countries, 10-25% of the population suffers from allergic rhinitis. Of particular interest for treatment are combination preparations containing topical corticosteroids and antihistamines, in particular, Glenspray Active. The active ingredients of the drug are mometasone furoate and azelastine hydrochloride. The purpose: study of effectiveness of the drug «Glenspray Active» usage in patients with allergic rhinitis. Results and discussion: 69 patients with allergic rhinitis were treated in the clinic of the SE «DMA of HM of Ukraine». In 61 patients intermittent AR was diagnosed, in 8 patients - persistent AR. Efficiency criteria were an assessment of the effect of therapy with the studied drug on the nasal symptoms of allergic rhinitis. To analyze the indicators, a general nasal symptom scale (TNSS – Total Nasal Symptom Score) was used, and the overall effectiveness of treatment by the patient and the research doctor was also evaluated. Most of patients (49-57%) noted a good and excellent effect from the use of the drug which occurred already between 30 and 60 minutes after the start of treatment. 85.5% of patients noted the maximum effect of the using of the drug which was between 30 and 60 minutes. Conclusion: The combined drug «Glenspray Active» is an effective and safe tool in the treatment of patients with AR. A good and excellent clinical effect in the form of a significant reduction in nasal symptoms (TNSS) occurs from 30 to 60 minutes in 44-57% of patients. The maximum effect from the use of the drug was observed between 30 and 60 minutes in 85.5% of patients.