Ultrastrukturelle Veränderungen der Nasenschleimhaut des Menschen nach Abusus von topischen α-Sympathomimetika

[Rhinitis medicamentosa]

One type of non-allergic non-infectious rhinitis is represented by a heterogeneous group of rhinitis medicamentosa, which can be divided into several pathogenetic types. The most common rebound nasal congestion associated with the use of topical decongestants. Excessive use of intranasal decongestants leads to a decrease in the number of alpha-adrenoreceptors on the surface of cell membranes and uncoupling their connection with the G-protein and the development of tachyphylaxis. To prevent the development of rebound nasal congestion caused by topical decongestants, it is important to limit the frequency of their use. In most cases, the duration of the use of vasoconstrictor drugs should be limited to 5-7 days, according to Patient information leaflets for the drugs. However, in patients who have had a history of episodes of rebound nasal congestion, which develops including the previously indicated periods, the duration of decongestant therapy should be limited to 3 days. Rhinitis associated with local inflammation is caused by the intake of acetylsalicylic acid (ASA) or other non-steroidal anti-inflammatory drugs. Currently, the so-called "aspirin triad" is well known - a combination of bronchial asthma, rhinosinusitis (often polyposis) and intolerance to ASA. Neurogenic rhinitis develops due to the use of drugs that violate vascular tone, for example, antihypertensive drugs or type 5 phosphodiesterase inhibitors. Drug-induced rhinitis has a significant impact on the patient's quality of life: nasal congestion, rhinorrhea, secondary night apnea, insomnia as a result of nasal breathing disturbances, headaches, irritability, weakness after sleepless nights disturb patients to a large extent. Timely diagnosis and withdrawal of a provocative drug, the use of topical corticosteroids in case of severe rhinitis are the basis of the treatment of rhinitis medicamentosa. In severe cases, there is a need, including surgical treatment, such as, for example, submucosal laser destruction of the lower nasal concha.

Topical glucocorticoid reduces the topical decongestant-induced histologic changes in an animal model nasal mucosa

OBJECTIVES/HYPOTHESIS

To investigate the histologic consequences of simultaneous nasal glucocorticosteroid and xylometazoline HCl administration in the rabbit nasal mucosa.

STUDY DESIGN

Prospective randomized study.

METHODS

Twenty New Zealand male rabbits were randomly placed into three groups: group I, control (n = 6); group II, xylometazoline HCl (n = 8); or group III, xylometazoline HCl-fluticasone furoate (n = 6). Group I received no treatment. Groups II and III received two intranasal puffs of xylometazoline HCl 0.5 mg/mL twice daily or two puffs of xylometazoline HCl 0.5 mg/mL twice daily plus one puff of 27.5 μg fluticasone furoate twice daily to each nostril (110 μg), respectively. At the end of 3 weeks, the rabbits were sacrificed. The mucosa of the nasal cavities was excised. Specimen sections (5 μm) were stained with hematoxylin and eosin, mucicarmine, and Gomori one-step trichrome and were examined under a light microscope. The presence of edema, congestion, inflammatory cell infiltration, nasociliary loss, epithelial and nerve-ending degeneration, and goblet cell increase were evaluated semiquantitatively (grades 0-3).

RESULTS

Statistically significant differences were detected between groups II and III in terms of edema, congestion, inflammatory cell infiltration, nasociliary loss, and epithelial degeneration (P = .006, P = .049, P = .015, P = .014, and P = .049, respectively). Nerve-ending degeneration, goblet cell increase, and quantitative goblet and neutrophil cell counts did not yield statistically significant differences between groups II and III (P = .137, P = .580, P = .770, and P = .616, respectively).

CONCLUSIONS

The combined simultaneous intranasal administration of xylometazoline HCl and fluticasone furoate appears to be beneficial in minimizing the long-term usage-associated congestion, edema, inflammatory cell infiltration, epithelial degeneration, and nasociliary loss in the rabbit model nasal mucosa.

Smoking, environmental tobacco smoke, and aspirin-exacerbated respiratory disease

BACKGROUND

Tobacco smoke is a widely recognized environmental pollutant and is a major public health hazard worldwide. Although environmental tobacco smoke (ETS) has a clear link with many conditions, including asthma, ear infections, and sinus cancer, evidence related to aspirin-exacerbated respiratory disease (AERD) requires further investigation.

OBJECTIVE

To investigate whether active smoke or ETS exposures are associated with an increased risk of developing AERD.

METHODS

A total of 260 patients with AERD were enrolled in a case-control study with their respective asymptomatic spouses serving as matched controls. Multiple logistic regression analysis was used to examine the association of AERD with active smoking and ETS, adjusted for age, sex, and location of childhood residence.

RESULTS

The AERD case patients were more likely to have ever smoked actively when compared with controls (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.04-2.28). A significant association (OR, 3.46; 95% CI, 2.22-5.39) was found between childhood ETS exposure and AERD. If a patient was exposed to ETS during both childhood and adulthood, results showed an OR of 5.09 for developing AERD (95% CI, 2.75-9.43). However, no statistically significant association between AERD and ETS only during adulthood was found (OR, 1.60; 95% CI, 0.75-3.40), suggesting that the combined effect of childhood and adulthood ETS may be augmented by the prior childhood exposure.

CONCLUSIONS

Active smoking and childhood ETS exposure are associated with increased odds of developing AERD. In particular, combined childhood and adulthood exposure had major effects. This study suggests that ETS is at least one contributor to the syndrome of AERD.

Physiology and pathophysiology of respiratory mucosa of the nose and the paranasal sinuses

In this review, anatomy and physiology of the respiratory mucosa of nose and paranasal sinuses are summarized under the aspect of its clinical significance. Basics of endonasal cleaning including mucociliary clearance and nasal reflexes, as well as defence mechanisms are explained. Physiological wound healing, aspects of endonasal topical medical therapy and typical diagnostic procedures to evaluate the respiratory functions are presented. Finally, the pathophysiologies of different subtypes of non-allergic rhinitis are outlined together with treatment recommendations.

[Immunocytochemical detection of caspase 3 in various diseases of human nasal mucosa]

BACKGROUND

Inflammatory processes play a central role in the pathogenesis of chronic rhinosinusitis (CRS), however, the impact of apoptosis in CRS in unclear. The aim of this study was a comparison of caspase 3 activity, a key enzyme in the apoptosis cascade, in samples of nasal tissue from patients with different types of rhinosinusitis.

MATERIAL AND METHODS

Immunohistochemical analyses were carried out to detect caspase 3 in samples of nasal tissue from patients with CRS and nasal polyps (NP), allergic rhinitis (AR), rhinitis medicamentosa (RM) and atrophic rhinitis.

RESULTS

Evidence of increased apoptosis was found in the epithelium, submucosal glands and blood vessels in NP samples. Samples of RM showed strong caspase 3 activity in the endothelial cells and the lamina muscularis of blood vessels. In atrophic rhinitis the epithelium and subepithelial glands showed increased caspase 3 activity. In samples of patients with allergic rhinitis caspase 3 activity could not be detected.

CONCLUSIONS

Activated apoptosis seems to play an important role in the pathogenesis of different types of rhinosinusitis. Further investigations on the induction of caspase 3 are necessary for the development of new therapeutic strategies to influence the regulation of apoptosis.

Mono- oder Kombinationstherapie mit einem Antihistaminikum

BACKGROUND

The guidelines of German and European associations of allergology recommend the treatment of severe allergic rhinitis with a combination of oral antihistamines and nasal steroids. Many patients face this option rather skeptically, so that ENT specialists mostly use antihistamine monotherapy with a higher dosage. This increased dose may cause drowsiness, as has been demonstrated for cetirizine and loratadine. However, ebastine is a non-sedating antihistamine. Furthermore, it has been shown that improved clinical efficacy can be attained with an increased dosage of 20 mg daily in comparison to the usual dosage of 10 mg/day without increasing the rate of side effects.

METHODS

In this prospective post-marketing survey, the treatment of 4,307 patients with allergic rhinitis was documented during the pollen season 2005. The severity of rhinitis symptoms and satisfaction with the treatment were recorded.

RESULTS

Treatment with 20 mg ebastine daily as monotherapy led to a significantly greater reduction in symptoms (P=0.002) than the combination therapy.

CONCLUSION

This outcome could be attributed to an assumed better compliance in patients with monotherapy.