The role of H2 antagonists in perennial allergic rhinitis

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

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.

Relationship between sleep quality and rhinitis in children: role of medical treatment with isotonic and hypertonic saline

BACKGROUND

The nose represents the port of entry, the first part of the upper airway and accounts for 50% of its total resistance. Many authors identified rhinitis as relevant factor affecting quality of life, and sleep habits of sufferers and their caregiver's, particularly between 4-17 years old children. Both allergic rhinitis and non-allergic rhinitis may represent an important risk for obstructive sleep apnea syndrome in children. We evaluated the quality of sleep and the role of nasal irrigations with saline solutions in children with sign and symptoms of rhinitis.

METHODS

An observational retrospective study was conducted on 58 children aged 3-6 years old receiving diagnosis of rhinitis according to clinical and amnestic evaluation. All recruited children were screened before medical topic treatment with the Pediatric Sleep Questionnaire test in order to evaluate the sleep habits and after isotonic and hypertonic saline nasal irrigation for six months. One-Way ANOVA was used for statistical analysis of the results.

RESULTS

Forty-nine of 58 recruited children reached the follow-up control after six months of medical treatment. Mean score at Pediatric Sleep Questionnaire before and after medical treatments was respectively 0.39 and 0.28. One-Way ANOVA test showed a significant statistical difference (P<0.05).

CONCLUSIONS

Nasal topic decongestant may be used only for short-term treatments, and they do not seem to have long-term results. Topic corticosteroids may be used for long term treatment and their correlations with OSA seem to have different results. This study aims to attracting the attention of pediatricians on the importance of nasal topic saline solutions irrigations in children with rhinitis in improving HRQoL decreasing snoring and apneas and so daytime symptoms.

Nasal mucosa healing after endoscopic sinus surgery in chronic rhinosinusitis of elderly patients: role of topic alpha-tocopherol acetate

BACKGROUND

Chronic rhinosinusitis (CRS) in European country ranges in elderly patients from 4.5 to 12% of population and has a significant effect on quality of life. In these patients, rhinosinusitis is linked to immune functions changes with age and to mucosal paraphysiological alterations such as crusting formations with atrophic epithelium, variations of nasal airflow and modifications of the mucociliary clearance. Failure of medical treatments leads to surgery in patients with persistent symptoms and radiographic signs of CRS. The choice of appropriate post-surgical topic treatments is important for healing time and for preventing mucosal complications such as synechiae, crusting formation and atrophy with secondary bacterial and fungal infections.

AIMS

Defining the effects of topic alpha-tocopherol acetate administration on nasal mucosa healing after endoscopic sinus surgery in CRS of elderly patients.

METHODS

In this study were included 32 patients, mean age 68.6, who underwent FESS because affected by CRS not responsive to medical treatments. After surgical treatment, we distinguish two groups basing on local nasal therapy.

RESULTS

We investigated, in the postoperative time, the role of alpha-tocopherol acetate compared to gomenol oil. Follow-up was performed at 7-15 days and 1-3 months after surgery. We evaluated mucosal restoration using Rhinoscopy Sum Score and quality of life using Nasal Six Items Symptom Questionnaire. We observed a faster healing time and less recurrence of complications in patients who underwent topic treatment with alpha-tocopherol acetate.

DISCUSSION

In our research, we observed that alpha-tocopherol acetate has no contraindications and side effects.

CONCLUSIONS

Our study showed the effectiveness of alpha-tocopherol acetate topic treatment in elderly patients affected by CRS after FESS, in improving and speeding up the process of restoring the sinonasal mucosa, compared to another topic medication.

Histamine H1 receptors are involved in mouse nasal allergic responses: a demonstration with H1 receptor-deficient mice

The role of histamine H1 receptors in nasal allergic symptoms (sneezing and nasal rubbing) were studied using histamine H1 receptor-deficient mice. Intranasal instillation of histamine solution resulted in significant increases in sneezing and nasal rubbing in wild-type mice, whereas no increases were observed in histamine H1 receptor-deficient mice. The histamine H1 receptor agonist 2-pyridylethylamine induced sneezing and nasal rubbing in a dose-dependent-manner in wild-type mice, but no such increase was found in histamine H1 receptor-deficient mice. On the other hand, the histamine H2 receptor agonist dimaprit did not increase sneezing and nasal rubbing in wild-type mice. Histamine H1 receptor antagonists such as chlorpheniramine and epinastine significantly inhibited nasal allergic symptoms caused by histamine, but the histamine H2 receptor antagonists cimetidine and famotidine showed no effect. No additional effects were observed by combined use of chlorpheniramine and cimetidine or famotidine compared with cimetidine or famotidine alone. These results suggested that histamine H1 receptors play an important role in nasal allergy symptoms induced by histamine.

Changes in serum interferon-gamma, interleukin-4, and interleukin-12 cytokine levels in anti-histamine type 2-treated allergic rhinitis patients

OBJECTIVES/HYPOTHESIS

Markedly elevated immunoglobulin E (IgE) synthesis characterizes allergic diseases. Interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) regulate IgE synthesis. It has been shown that immunotherapy and histamine type 2 (H2) receptor antagonists induce a clinical improvement, decrease IgE antibodies, and increase T-cell subsets, which express a suppressor function. In addition, immunotherapy brings about a reduction in the amount of IL-4 in T-cell clones of allergic individuals. The purpose of this study was to investigate the profile of cytokines IFNgamma and IL-4 that occurs in vivo in anti-H2-treated patients with allergic rhinitis (AR).

METHODS

Enrolled were 65 AR patients with sensitivity to a single allergen, the Parietaria, 36 of whom were randomly assigned to treatment with ranitidine at a dosage of 1 mg/kg per day intravenously for 20 days, and 29 to placebo treatment.

RESULTS

A comparison of the serum cytokine values recorded before and after anti-H2 treatment showed a significant increase in INF-gamma serum level (P = .003) and a decrease in IL-4 (P = .016). Negligible variations were found in the placebo-treated group.

CONCLUSION

H2 antagonists probably induce their effects by enhancing the amount of IFN-gamma and by reducing IL-4 cytokines, which, respectively, induce a decrease and an increase in the IgE synthesis.

Carbon dioxide laser turbinate surgery for chronic obstructive rhinitis

BACKGROUND AND OBJECTIVE

The argon laser was first used to treat chronic obstructive rhinitis. Several other surgical lasers were later used to perform inferior turbinotomy. What is the ideal laser for turbinate surgery?

STUDY DESIGN/MATERIALS AND METHODS

CO(2) laser with its longer wavelength (10.6 micrometer) scatters less on tissues, is less harmful than the other surgical lasers, minimizes local edema with very little damage to the nearby mucosa, and achieves excellent haemostasis. But CO(2) laser energy delivered through a fiberoptic cable is partially absorbed by the transmitting fiber. CO(2) laser delivered through surgical microscope obviates this problem, and a special self-retaining nasal speculum allows the surgeon to have both hands free to more easily perform inferior laser turbinotomy, creating a deep groove along the turbinate body.

RESULTS

The laser vaporized tissues formed scar tissue, reduced turbinate bulk, restored nasal flow, and improved other symptoms: rhinorrhoea, sneezing, headache with a statistically significant reduction in total nasal airway resistance (NAR), P < 0.005, at 2 year follow-up.

CONCLUSION

The CO(2) laser delivered through surgical microscope with the help of a self-retaining nasal speculum can be deemed a useful laser for turbinate surgery.

Suppressor T cell subsets in allergic rhinitis patients

Lymphocyte T cell subsets, total and Parietaria IgE levels were studied in 68 allergic rhinitis patients. In treated patients we observed an increase in the lymphocyte T cell subsets, which express a suppressor function, defined by several monoclonal antibodies, i.e., CD8, CD8 + CD11b-, CD4 + CD62L+, CD4 + CD45RO. This increase was significant for T suppressor cells, CD8 + CD11b- (p < 0.046) and T memory cells, CD4 + CD45RO (p < 0.013), whereas a slight decrease was observed in the control group. A decrease in total serum IgE levels was observed in anti-H2 treated patients; only a slight increase was noted in placebo groups; and no variations were found in Parietaria levels in either group. In vitro culture of T lymphocyte clones, T memory cells, from atopic subjects produces IL-4, which induces an increase in IgE synthesis. An increase in T memory cells, observed in the treated group, should have accompanied an increase and not a decrease in total serum IgE levels, if the in vivo data correlated with those in vitro. Consequently, the behaviour of lymphocytes in vivo is not homologous to in vitro data.

Histamine-2 receptor antagonists as immunomodulators: new therapeutic views?

Considerable evidence has emerged to suggest that histamine participates in the regulation of the inflammatory response, immune reaction, coagulation cascade, and cardiovascular function. Furthermore, histamine may play a major role in the growth of normal and malignant tissue as a regulator of proliferation and angiogenesis. Specific histamine receptors have been identified on the surface of bone marrow cells, immune competent cells, endothelial cells, fibroblasts, and also on malignant cells. This has prompted research in regulation by specific histamine receptor agonists and antagonists. Results from such studies are currently accumulating and suggest that the histamine-2 receptor antagonists have potential beneficial effects in the treatment of certain malignant, autoimmune and skin diseases, either alone or in combination with other drugs. The beneficial effect of histamine-2 receptor antagonists as adjuvant single drugs to reduce trauma-, blood transfusion- and sepsis-induced immunosuppression has led to research in combined treatment regimens in major surgery, particularly, of patients operated on for malignant diseases.

Effect of H1 and H2 antagonists on nasal symptoms and mediator release in atopic patients after nasal allergen challenge during the pollen season

During the pollen season, quantitative determination of the chemical mediators and eosinophil count was performed in 16 patients with hay fever after nasal allergen challenge (NAC). The aim of this study was objectively to assess the effect of H1 and of a combination of H1 and H2 antagonists on nasal symptoms, mediator release, and eosinophil count during an allergic reaction. NAC was performed at baseline (V1), 2 weeks after treatment with cetirizine 10 mg/day (V2), and after a combined therapy with cetirizine 10 mg and cimetidine 800 mg a day during the following week (V3). Results showed a significant (p < 0.05 or p < 0.01) relief of nasal symptoms such as: itching, sneezing, rhinorrhea and congestion, and of objective parameter such as: reduction of the number of sneezes after NAC at V2 and V3. Neither H1 antagonist nor a combination of H1 and H2 antagonists showed any effect on eosinophilia and ECP concentration caused by natural allergen exposure, nor on histamine and tryptase release immediately after NAC. When a combination of H1 and H2 antagonists was administered significant reduction of the nasal airway resistance and increase of the nasal air flow were demonstrated.