The influence of female sex hormones on nasal reactivity in seasonal allergic rhinitis

CLEC16A variants conferred a decreased risk to allergic rhinitis in the Chinese population

Background: Allergic rhinitis (AR) is a chronic respiratory disease. Hereditary factors played a key role in the pathogenesis of the AR. This study investigated the association between CLEC16A variants and AR risk in the Chinese population. Methods: We applied Agena MassARRAY technology platform to genotype five single nucleotide polymorphisms (SNPs) located in CLEC16A in 1004 controls and 995 cases. The association between CLEC16A SNPs (rs2286973, rs887864, rs12935657, rs11645657 and rs36045143) and AR risk were calculated by logistic regression analysis, with odds ratio (OR) and 95% confidence interval (CI). False-positive report probability (FPRP) was also used to assess the significant results to reduce false positives. Multifactor dimensionality reduction (MDR) was completed to assess the interaction between CLEC16A variants to predict AR risk. Results: Totally, CLEC16A (rs887864, rs12935657, rs2286973, rs11645657 and rs36045143) were significantly associated with AR risk. Therein, rs2286973, rs11645657 and rs36045143 were related to a decreased risk of AR in the people ≤ 43 years old, females and the people with BMI≤24, respectively. And rs887864 and rs12935657 were also associated with a decreased susceptibility of AR in the people >43 years old. Meanwhile, in the results of region stratification, rs887864 conferred a reduced risk to AR in the people from loess hilly area. Conclusion: CLEC16A variants conferred a decreased risk to AR in the Chinese population.

Level of sex hormones and their association with acetylsalicylic acid intolerance and nasal polyposis

BACKGROUND

Chronic rhinosinusitis may be associated with nasal polyposis. Recurrence of disease is often observed and may be due to an intolerance of acetylsalicylic acid. Sex hormones are known to modulate allergic reactions and inflammation. Whether they may be involved in the development and progression of nasal polyposis has not been investigated yet.

AIM

Examine the relationship between levels of sex hormones and nasal polyposis.

METHODS

Hormonal levels (estradiol, testosterone and progesterone) in patients with nasal polyposis (n = 26) with or without acetylsalicylic acid-intolerance were determined and compared to hormonal levels in patients with septal deviation (n = 35). Cone-beam computed tomography scans were analysed by using scores as defined by Lund and Mackay and by Kennedy.

RESULTS

Our results show a 5 times greater odds (p = 0.01) for developing nasal polyposis in the presence of lowered estradiol plasma levels than in the presence of normal / elevated levels. When analyzing females and males separately, a 6 times greater odds for females to develop nasal polyposis in the presence of lowered estradiol plasma levels was calculated (p = 0.02). Thus, females are more likely to develop nasal polyposis when they have lowered estradiol levels than males. In addition, female patients showed an increased risk for developing ASA intolerance (p = 0.01).

CONCLUSION

Variation of sex hormones may be involved in nasal polyposis. Further studies including more patients to validate the presented results are required.

SIGNIFICANCE

Retrospective clinical investigation suggesting a correlation between varying sex hormones and nasal polyposis.

Rhinitis 2020: A practice parameter update

This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.

Contraceptive Use Affects Overall Olfactory Performance: Investigation of Estradiol Dosage and Duration of Intake

The influence of female sex steroids on cognitive performance and sensory perception has been investigated for decades. However, previous research that studied olfaction revealed inconsistent results. The main aim of this study was to investigate the effects of different ethinyl estradiol (EE) concentrations of oral contraceptives and duration of intake on olfactory function. Forty-two healthy women, with regular intake of either high or low EE dosage over at least one year and up to 15 years participated in this study. Results revealed a significant concordance between a priori categorization in the two groups with high and low EE dosage and data-driven hierarchical clustering (p = 0.008). Furthermore, significantly higher olfactory performance was observed in women using low-dose products compared to women using high-dosed products (p = 0.019). These findings indicate different effects of pill use with regard to EE concentration. We therefore strongly recommend the acquisition of information about EE dosage of oral contraceptives to reduce potential confounding factors when investigating sensory systems.

Intermittent nasal carriage with Staphylococcus aureus within a menstrual cycle: Results from a prospective cohort of healthy carriers

Female sex hormones have been related to nasal Staphylococcus aureus carriage in healthy individuals; however, whether nasal staphylococcal carriage varies by menstrual cycle phase remains unknown.We sampled anterior nares of female healthcare workers twice per week for 6 consecutive menstrual cycles. We used mixed-effects Poisson regression models to determine whether intermittent carriage was associated with cycle phases in a given individual. We also performed recurrent event survival analysis to identify host factors linked to incident carriage status.Overall, we collected 754 nasal swabs over 89 consecutive person-cycles from 14 intermittent carriers. In 84 ovulation-defined menstrual cycles (715 swabs), the period prevalence of staphylococcal carriage was 58.7%, 63.1%, and 64.9% in the follicular, periovulatory, and luteal phases, respectively; these differences were not statistically significant after multivariable adjustment and correction for within-person correlation (adjusted relative risk [RR]-periovulatory 0.92, P: 0.30; luteal 1.00, P: 0.98).Using survival analysis, we identified several host factors that were associated with incident loss, gain of colonization, or both. For example, as compared to women aged 20 to 30 years, those aged 30 to 40 years were less likely to losing carriage (hazard ratio [HR]: 0.26, 95% confidence interval [CI]: 0.09, 0.80) but were as likely to regaining carriage (HR: 0.53, 95% CI: 0.21, 1.34). In comparison, being underweight (body mass index [BMI] <18.5) was significantly associated with a higher risk for regaining (HR: 1.95, 95% CI: 1.34, 1.51) and losing (HR: 1.57, 95% CI: 1.16, 2.12) colonization, indicating the alternating tendency for status changes. Personal hygiene behaviors, such as nostril cleansing habit and methods, differentially affected carriers' risk for losing or regaining staphylococcal colonization.Using an intensive sampling scheme, we found that nasal staphylococcal carriage could vary substantially over time in healthy carriers. Yet, such dynamic intraperson changes in carriage status did not depend on menstrual cycle phases but were associated with host age, BMI, and personal hygiene behavior.

The rhinological manifestations of women's health

OBJECTIVE

To systematically review the literature and appraise the evidence reporting the effects of women's health, including pregnancy, postpartum, menstruation, oral contraception, menopause, and hormone replacement therapy, on common rhinological pathologies and nasal physiology.

DATA SOURCES

Systematic search strategy using MEDLINE (1966-2012) and EMBASE (1980-2012) databases.

REVIEW METHODS

Title review, abstract screening, and then full paper analysis were undertaken by 2 authors independently. Level of evidence was graded according to the Oxford Centre of Evidence Based Medicine 2011 criteria and risk of bias assessment using the Jadad scale for randomized controlled trials and Newcastle-Ottawa Scale for cohort and case-controlled studies.

RESULTS

Over the 46 years analyzed, the search strategy produced 2904 titles. In total, 314 abstracts were screened, from which 192 full-text articles were evaluated, and 145 research papers met all the criteria for inclusion in the study. Overall, the available evidence was of low quality. Seventy percent of studies (102 of 145) were case reports or case series from which only limited conclusions can be drawn. Only 3% of the included papers (4 of 145) were randomized controlled studies. The remaining data were mainly of a prospective cohort design. Study heterogeneity in design and measured outcomes resulted in data synthesis being limited to a descriptive/exploratory review. Study findings are presented by women's health category and then by rhinological manifestation with important clinical correlations highlighted.

CONCLUSION

Physiological and hormonal changes occurring as a normal part of women's health have an important influence on rhinological function and disease.

The effect of female hormone manipulation on nasal physiology

BACKGROUND

This study was performed to establish whether the ovarian hormone beta-estradiol has any influence on nasal physiology when manipulated during in vitro fertilization treatment.

METHODS

Women undergoing in vitro fertilization (IVF) treatment at the Assisted Conception Unit, Leicester Royal Infirmary, were recruited. Nasal peak inspiratory flow rate, acoustic rhinometry, anterior rhinomanometry, mucociliary clearance, olfactory thresholds, quality of life, and serum 17-beta-estradiol levels were measured at each visit. Subjects were studied at the beginning of their IVF treatment and then at one or two additional occasions while they received synthetic follicule-stimulating hormone with a final set of results taken at the end of their treatment.

RESULTS

Results were analyzed using paired t-tests. There was no statistical difference between any of the data sets for any of the variables during the process of IVF treatment.

CONCLUSION

Increasing levels of beta-estradiol that occur in IVF treatment cause no significant effect on nasal physiology in contrast to the effects seen during pregnancy.

Self-Reported Snoring, Maternal Obesity and Neck Circumference as Risk Factors for Pregnancy-Induced Hypertension and Preeclampsia

BACKGROUND

Physical and hormonal changes during pregnancy alter breathing patterns of pregnant women. It is possible that occult disordered breathing during sleep may be a risk factor for the development of pregnancy-induced hypertension (PIH) and preeclampsia.

OBJECTIVE

Our aim was to determine the incidence of self-reported snoring in pregnant women, and to investigate the relationship of snoring, obesity and neck circumference to PIH and preeclampsia.

METHODS

469 pregnant women and 208 age-matched nonpregnant women were included in the study. Both groups were asked to complete a questionnaire. Maternal complications were retrieved from the medical records.

RESULTS

Habitual snoring was reported from 1.9% of nonpregnant women, 2.5% of pregnant women prior to pregnancy and 11.9% of those same women during the third trimester of pregnancy (p < 0.001). Age, smoking during pregnancy, and weight before delivery were independent risk factors for habitual snoring in pregnancy. PIH and preeclampsia developed in 20 and 10.9% of pregnant women with habitual snoring, as compared to 11 and 5.8% of non-snoring pregnant women (p = 0.045, p = 0.125, p = 0.415), respectively. In women who developed preeclampsia, weight before pregnancy, weight before delivery and neck circumference were significantly higher in univariate analysis. Neck circumference was an independent risk factor for PIH and preeclampsia according to logistic regression analysis.

CONCLUSION

The incidence of snoring is significantly higher in pregnant women than in nonpregnant women. Snoring may indicate a risk of PIH. Neck circumference was an independent risk factor for both PIH and preeclampsia.

Allergic rhinitis in women

Allergic rhinitis is a high-prevalence disease that significantly impairs the quality of life. Its pathogenesis is quite well understood, and involves numerous cells, cytokines and mediators, which result in an inflammatory process. The triggering IgE-mediated reaction does not differ between men and women, but in females some aspects, related mainly to the hormonal frame, must be taken into account. In fact, cyclic hormonal changes can affect the severity of rhinitis, as can pregnancy, which may result in a particular form of 'pregnancy rhinitis'. The most important and challenging aspect is the management of allergic rhinitis in pregnancy, which require a careful evaluation of the risk:benefit ratio. This review will examine the aforementioned aspects, with particular regard to the pharmacotherapy of rhinitis in pregnancy.

A scanning electron microscopic study of nasal respiratory epithelium in pregnant rats

Pregnancy is a very important period in mammals. Various morphological and functional changes can be observed. Some studies examining nasal epithelial structure deal with changes found in pregnancy. In this study, a total of 16 adult female Sprague Dawley rats (8 control and 8 pregnant) were used. They were anesthetized with ketamine and sacrificed via cardiac perfusion with 2.5%-glutaraldehyde solution (in 0.1 M sodium phosphate buffer, pH 7.4). The heads of the rats were bisected midsagittally and one half was completely passed through the routine histological procedures for SEM examination. On the apical surfaces of ciliated cells of pregnant rat respiratory epithelium disoriented cilia and cilia with dilated blebs at their free ends were observed. In addition, some masses of mucus due to hypersecretion were striking. Goblet cells appeared swollen and their apical surfaces showed microvilli varying considerably in length and number.

The immune system as a target for environmental chemicals: Xenoestrogens and other compounds

The immune system in higher organisms is under integrated control and has the capacity to rapidly respond to the environment. Recently, there has been a significant increase in the prevalence of allergic diseases. Environmental factors likely play a major role in the explosion of allergy. Although the "hygiene hypothesis" may explain the increase in allergic diseases which are prone to T helper 2 (Th2) immune responses, recent findings highlight the possible involvement of environmental xenobiotic chemicals which can modulate normal immune function. Interestingly, several reports suggest that the prevalence of systemic lupus erythematosus, a Th2-type autoimmune disease, is also increasing, although the development of high-sensitivity immunological tests may be a possible cause. The increased prevalence of autoimmune disease in women, the sexual dimorphism of the immune response, and the immunomodulatory effects of sex steroids, have focused attention on the role of chemicals which influence sex steroids in the development of immune diseases. Moreover, recent reports indicate that some environmental chemicals can work on nuclear hormone receptors, other than sex hormone receptors, and modulate immune reactions. This review focuses on the impact of environmental chemicals on immune system function and pathogenesis of immune diseases, including allergy and autoimmune diseases.

Does hormone therapy increase allergic reactions and upper gastrointestinal problems? Results from a population-based study of Swedish woman. The women's health in the Lund area (WHILA) study

OBJECTIVES

To delineate the use of various drugs particularly pertaining to allergy and upper gastrointestinal problems in relation to hormone status in middle aged women.

METHODS

An analysis from a population-based study on women born between 1935 and 1945 and lived in the Lund area southern Sweden. Of 10,766 women, 6,917 provided complete data sets; in turn 5,673 were assessed for the use of medication in this study. Among the cohort, 9% of women were premenopausal (PM), 54% were postmenopausal without hormone replacement therapy (PM0) and 37% were current hormone replacement therapy users (PMT).

RESULTS

There were 7 (1.3%) women in PM, 11 (0.4%) in PM0 and 21 (1.0%) in PMT group who used loratadine regularly. There was a significant difference between the PM and PM0 groups and also between the PM0 and PMT groups in the use of loratadine (P < 0.05 ). Among 21 loratadine users in PMT group 4 (19%) used transdermal patches and 17 (81%) used oral HRT. The result for omeprazole use was as follows: 4 (0.8%) of PM group, 39 (1.3%) of PM0 group and 42 (2.0%) of PMT group. The use of omeprazole was significantly higher in the PMT group than in the PM (P = 0.05 ) and PM0 group (P < 0.05 ). There was no relation between the use of omeprazole and smoking or alcohol consumption.

CONCLUSIONS

Use of hormone replacement therapy seems to be related to a higher frequency of omeprazole and loratadine use, which implies that hormone replacement therapy, may be associated with more upper gastrointestinal symptoms as well as allergy.

The effect of the steroid sex hormones on the nasal airway during the normal menstrual cycle

The changes in the nasal mucosa during the menstrual cycle have been little researched and the role of oestrogens debated. The aim of this study was to measure a spectrum of physiological parameters in relation to the peak and trough of these hormonal levels. Ten women underwent measurements at the onset of menses and at the time of ovulation. On each occasion, anterior rhinoscopy, peak inspiratory nasal flow, acoustic rhinometry, anterior rhinomanometry, mucociliary clearance time and rhinitis questionnaire score were recorded. All measurements except anterior rhinoscopy showed a difference between the two readings consistent with nasal congestion at the peri-ovulatory stage of the cycle, of which anterior rhinomanometry and mucociliary time were significant (P <or= 0.05). Nasal congestion therefore occurs in conjunction with the rise in serum oestrogens that occur at ovulation in the normal menstrual cycle. Pharmacological antagonism of oestrogens may therefore relieve nasal congestion and is currently under further research.

Immunoglobulin E- (IgE) and non-IgE-mediated reactions in the pathogenesis of atopic eczema/dermatitis syndrome (AEDS)

AEDS is a chronic, relapsing, highly pruritic inflammatory skin disease that commonly begins in childhood. Two forms of this disorder exist, i.e. an allergic (extrinsic) form and a nonallergic (intrinsic) form. There are clear genetic, humoral and cellular differences between the allergic and nonallergic forms of AEDS. The allergic variants express local IgE production in affected tissue and both allergic and nonallergic triggers play a major role in the expression of disease. The role of allergens is very important in the immunopathogenesis of AEDS. Nonimmunological triggers play a secondary modulatory role often hampering treatment effort and optimal response to therapeutic efforts.

Allergic and nonallergic forms of atopic diseases

Atopic dermatitis, allergic rhinitis, and asthma are atopic diseases that develop on a complex genetic background, the so-called atopic diathesis. Although they target different organs, in most patients they are characterized by the presence of elevated total serum IgE levels. However, a subgroup of atopic patients exhibits normal IgE levels and mechanisms contributing to the so-called "intrinsic" or "nonallergic form" have been the matter of intensive research work in the last years. Because of the rapid advancements in the research field of atopic diseases, it now becomes possible for the first time to delineate a new disease classification of allergic and nonallergic subtypes of atopic diseases, thereby bringing hope to the clinician for a more specific treatment approach for each subgroup of these patients.

The impact of estrogen and progesterone on asthma

OBJECTIVE

This paper describes evidence of a positive effect of both endogenous and exogenous estrogen and progesterone on lung function across the life span in women.

DATA SOURCES

Articles were identified using the keywords asthma, pulmonary function, menarche, menopause, estrogen, progesterone, hormone replacement therapy, oral contraceptives, and menstrual cycle from years 1966 to 2001 in MEDLINE. Additional studies were identified from article reference lists.

STUDY SELECTION

Relevant, peer-reviewed original research articles in the English language were selected.

RESULTS

Estrogen and/or progesterone may alter pulmonary function and asthma. Premenopausal women experience decreases in pulmonary function and increases in asthma exacerbations and hospitalizations during the premenstrual and menstrual phases. Oral contraceptives and hormone replacement therapy are associated with improved pulmonary function and decrease in asthma exacerbation. Some asthmatic patients experience improved pulmonary function and reduced asthma medication requirement during pregnancy.

CONCLUSIONS

Estrogen and progesterone modify airway responsiveness. Further research is needed to elucidate the clinical relevance of estrogen and progesterone in the pathophysiology and therapy of asthma.

Association between skin test diagnosed atopy and professionally diagnosed depression: a Northern Finland 1966 Birth Cohort study

BACKGROUND

Several studies have suggested an association between IgE-mediated atopic allergies and depression, although thus far no epidemiologic evidence involving a large, unselected, general-population sample and valid methods in diagnosing atopy support this putative association.

METHODS

We used the Northern Finland 1966 Birth Cohort, which was followed prospectively to age 31. Of the total cohort, 5428 individuals underwent skin tests for three of the most common allergens (i.e., cat, birch, and timothy grass) and for dust mites (Dermatophagoides pteronyssinus). Data on doctor-diagnosed lifetime depression were obtained from questionnaires.

RESULTS

After adjusting for social class, mothers' parity, place of residence, and psychiatric morbidity, the logistic regression analysis showed that the risk of developing depression when compared with nonatopic subjects increased up to 1.8-fold in atopic women (adjusted odds ratio 1.8, 95% confidence interval [CI] 1.2-2.6) and, when compared with skin-test-negative female subjects without allergic symptoms, reached 2.7-fold increases (95% CI 1.6-4.6) in those suffering from clinically manifest atopic disorders. Corresponding associations were not found among male subjects.

CONCLUSIONS

Our results indicate that women suffering from atopic diseases may possess an elevated risk for developing depression during early adulthood. Possible background theories (i.e., genetic abnormalities in serotonin metabolism, hypothalamic-pituitary-adrenal axis dysfunction, and histamine theory) are discussed.

Sleep disordered breathing and pregnancy

Many changes in the respiratory system occur during pregnancy, particularly during the third trimester, which can alter respiratory function during sleep, increasing the incidence and severity of sleep disordered breathing. These changes include increased ventilatory drive and metabolic rate, reduced functional residual capacity and residual volume, increased alveolar-arterial oxygen gradients, and changes in upper airway patency. The clinical importance of these changes is indicated by the increased incidence of snoring during pregnancy, which is likely also to reflect an increased incidence of obstructive sleep apnoea/hypopnoea syndrome. For the respiratory physician asked to review a pregnant patient, the possibility of sleep disordered breathing should always be considered. This review first examines the normal physiological changes of pregnancy and their relationship to sleep disordered breathing, and then summarises the current knowledge of sleep disordered breathing in pregnancy.

Prevalence and differential diagnosis of chronic rhinitis

The prevalence and differential diagnosis of rhinitis changes as we progress from birth to senescence. The heavy burden of allergic rhinitis is often overlooked in infants and disregarded in childhood and adolescence. In women, especially during pregnancy, hormonal changes can significantly affect nasal mucosal hyperreactivity and worsen ongoing syndromes. Various types of inflammatory and noninflammatory nonallergic rhinitides become more prevalent in the fifth decade and beyond. The burgeoning elderly population with irritant, atrophic, and medication-related rhinitis will constitute a greater proportion of our practices as the general population ages.

Allergic vulvovaginitis

LEARNING OBJECTIVES

The reader of this review will learn about the different clinical forms of allergic vulvovaginitis. This specific and important chapter has not been previously summarized and described in the medical literature. Vaginal mucosa is also able to show an allergic response similarly to the nose, eyes, lungs, and skin. Physicians should be familiarized with this kind of manifestation in order to make the proper diagnosis and evaluation of this entity.

DATA SOURCES

MEDLINE searches were undertaken since 1966 for citations of any kind of allergic vulvovaginitis. Relevant reviews and articles identified in this process were surveyed for additional and earlier citations. Textbooks of medicine, gynecology, dermatology, and infectious diseases have also been consulted. Old medical textbooks and journals of allergy and internal medicine were recovered from the Division of History of the Medicine of the Faculdade de Medicina da Universidade Federal de Minas Gerais (Federal Medical College), Belo Horizonte, Brazil.

CONCLUSIONS

A great variety of allergens are able to provoke allergic reactions in the female genital tract. The immunology of the vagina, the influence of hormones, menstrual cycle, and psychologic factors are also highlighted in this review. A possibility of vaginal hyperreactivity is proposed in this text. Adequate management provides important relief of symptoms in the majority of cases.

The immune system as a potential target for environmental estrogens (endocrine disrupters): a new emerging field

It is now well known that natural (17beta-estradiol) and synthetic (e.g. diethylstilbestrol) estrogens not only affect the reproductive system, but also markedly influence the immune system. Recently, a new class of estrogens that is abundant in the environment (in industrial chemicals, pesticides, and surfactants) has been recognized. Some of these estrogenic chemicals (which are a large subgroup of endocrine disrupters) have also been shown to influence the immune system. This review assimilates growing evidence in wildlife, laboratory animals and to a limited extent in humans, which suggests that environmental chemicals may also affect the immune system. Further studies are needed to ascertain the immunological consequences of exposure to environmental estrogens, especially in humans. At the present time, it is not known whether the human immune system responds to a low dose of environmental estrogens or if environmental estrogens influence certain subsets of human populations, rather than the general population. Conceivably, an alteration of the immune system by environmental estrogens could affect the individuals' ability to mount well-regulated immune responses to microbial and vaccine antigens, allergens, self and tumor antigens. Possible changes in the immune system must be investigated routinely in toxicity studies. A comprehensive mechanistic understanding of potential immunomodulatory chemicals is needed. In this regard, relevant laboratory animals may be especially useful in identifying susceptible periods of life, whether both genders are equally affected, in analysis of changes in target lymphoid organs, and to determine the immunological effects of mixtures of chemicals.