Histamine release from nasal mucosal mast cells in patients with chronic hypertrophic non-allergic rhinitis, after parasympathetic nerve stimulation

Efficacy of Selective Vidian Neurectomy for Allergic Rhinitis Combined with Chronic Rhinosinusitis

OBJECTIVE

The aim of this study was to investigate the efficacy of endoscopic selective vidian neurectomy in the treatment of severe persistent allergic rhinitis (AR) combined with chronic rhinosinusitis (CRS) with nasal polyps (ARwCRSwNP).

METHODS

One hundred thirty patients with moderate to severe persistent ARwCRSwNP were enrolled at Xuanwu Hospital, Capital Medical University, from September 2015 to September 2017. Patients were divided into 2 groups. Sixty-one patients (the control group) underwent conventional surgical treatment for CRS with nasal polyps and received conservative treatment for AR. Sixty-nine patients (the experimental group) received conventional surgical treatment for CRS with nasal polyps plus endoscopic selective vidian neurectomy with amputation of the posterior nasal nerve and pharyngeal branch of the vidian nerve. Clinical parameters, including visual analog scale (VAS) score, Lund-Kennedy endoscopic mucosal morphology score, and Lund-Mackay sinus computed tomography (CT) scan lesion range score, were used to analyze and evaluate the preoperative and postoperative data. Comparisons were based on patient scores, and preoperative and postoperative scores obtained at 6, 12, and 24 months were analyzed.

RESULTS

The experimental group had higher therapeutic efficacy in nasal obstruction, nasal itching, rhinorrhea, sneezing, and general symptoms than the control group (p < 0.05). No complications such as tear-secretion disorder or atrophic rhinitis occurred in the experimental group, and no significant difference in complications incidence was observed between the 2 groups (p > 0.05).

CONCLUSION

Endoscopic selective vidian neurectomy is an effective and safe technique for the management of moderate to severe persistent ARwCRSwNP.

Intimate behavior and allergy: a narrative review

OBJECTIVE

To determine how sex and intimate contacts can represent a risk factor for allergic reactions, because they may favor direct contact with sensitizing substances.

DATA SOURCES

We collected in this review the available literature on this subject. The MEDLINE database was searched by a combination of keywords: sex OR sexual intercourse OR kiss OR seminal plasma OR condom AND allergy OR allergic reaction.

STUDY SELECTION

The studies retrieved were independently evaluated by the authors and included in this review based on their clinical pertinence (i.e., dealing with clinical presentation, diagnosis, or treatment).

RESULTS

Sex and intimate behavior seem to be increasingly described as triggers of allergic reactions, although the pertaining literature is represented mostly by case reports. Kissing has been described as a risk factor for food- and drug-induced severe reactions. Seminal plasma allergy has been repeatedly described and investigated. In this case, practical diagnostic algorithms have been proposed, and desensitization protocols are available. Similarly, there are numerous case reports of allergic reaction due to latex condoms, for which the diagnostic procedure is standardized.

CONCLUSIONS

The available literature on intimate behavior, and sex in general, as a trigger of allergic reactions is not abundant. This is probably because of the particular nature of the problem, which concerns intimacy. Nevertheless, reliable diagnostic procedures are available in some specific cases. The possible link between sex and allergy should become part of the personal culture of allergists to extend and improve the diagnosis of unusual or unexplained conditions.

Plasma protein extravasation induced in the rat dura mater by stimulation of the parasympathetic sphenopalatine ganglion

It has been proposed that migraine could result from a neurogenic inflammation of the dura mater. According to this theory, inflammation could be initiated by an axon reflex of nociceptive nerve fibers, but the trigger of this axon reflex remains poorly understood. Previous works have shown that parasympathetic agonists can activate mast cells and/or sensory C-fibers, inducing pain and inflammation. The aim of the present work was to determine whether the activation of intracranial parasympathetic nerve fibers could trigger an inflammatory mechanism within the rat dura mater. Activation of the intracranial parasympathetic system was achieved by electrical stimulation of the sphenopalatine ganglion (SPG). The development of a neurogenic inflammation was estimated either by microscopic examination or by quantitative measurement of plasma protein extravasation (PPE) in the dura. To determine the respective roles of the parasympathetic and sensory innervations, two groups of rats were pretreated either with atropine or with capsaicin. Stimulation of the SPG induced a PPE increase of about 200% in the stimulated side on the dura mater. Extravasated material was mainly concentrated around small blood vessels. This extravasation was significantly reduced by capsaicin pretreatment and completely abolished by atropine. Infusion of carbachol in the common carotid artery induced PPE in the ipsilateral dura comparable to that induced by electrical stimulation of the SPG. This extravasation was also blocked by atropine infusion. These data indicate for the first time that the parasympathetic nervous system can trigger a neurogenic inflammation in the dura via muscarinic cholinergic receptors. Sensory C-fibers seem to play a role in this phenomenon. With respect to the potential autonomic imbalance described in the etiology of various types of vascular headaches, such a mechanism could be important in inducing attacks.

Carbachol-induced bladder mast cell activation: augmentation by estradiol and implications for interstitial cystitis

OBJECTIVES

Interstitial cystitis (IC) is a painful, sterile bladder disorder that occurs primarily in women, many of whom also experience allergies with symptoms that worsen perimenstrually. Increased numbers of activated bladder mast cells have recently been implicated in the pathophysiology of IC. These mast cells express high-affinity estrogen receptors and are located close to increased bladder nerves, many of which contain the neuropeptide substance P (SP). We therefore investigated whether the neurotransmitter acetylcholine (ACh) and SP could activate bladder mast cells and whether estradiol could influence this effect.

METHODS

Bladder pieces from male Sprague-Dawley rats were perfused with carbachol (the stable analogue of ACh), SP, or the mast cell secretagogue compound 48/80 (C48/80) with or without preincubation with beta-estradiol. The effect of carbachol was also investigated after pretreatment with the muscarinic antagonist atropine. Mast cell activation was assessed by release of 3H-serotonin and morphologic evidence of secretion by light and electron microscopy.

RESULTS

Carbachol triggered rat bladder mast cell serotonin release in a dose-dependent manner, an effect increased by tissue pretreatment with estradiol and blocked by atropine. The effect of carbachol was accompanied by ultrastructural evidence of mast cell activation and was stronger than that obtained by either C48/ 80 or SP.

CONCLUSIONS

Bladder mast cell activation is neurogenically mediated and augmented by estradiol, findings that could possibly explain the painful symptoms of IC and its prevalence in women, as well as the worsening of symptoms perimenstrually.

Interactions of mast cells with the nervous system ?Recent advances

This article reviews recent advances in the understanding of mast cell-nervous system interactions. It is drawn largely from work published within the last ten years, and discusses the anatomical and biochemical evidence of a functional connection between mast cells and the nervous system, and the implications that such a relationship may have for normal and abnormal physiological functioning. Mast cells are found at varying levels of association with the nervous system; in CNS parenchyma (mainly thalamus), in connective tissue coverings (e.g. meninges, endoneurium), and in close apposition to peripheral nerve endings in a variety of tissues. There is, as yet, no clearly defined role for mast cells in nervous system function, or vice-versa, and it seems most likely that their interactions fulfil mutually modulatory roles. By extension, pathological situations where one of the partners in this relationship is overly stimulated may lead to a dysregulation of the other, and contribute to disease symptomatology.

Postcoital asthma and rhinitis

Sexual intercourse as a trigger factor for attacks of asthma and/or rhinitis and the morbidity caused thereof is not well recognized. We present four patients (three males and one female) with postcoital asthma and/or rhinitis. Acute severe asthma subsequent to sexual intercourse in one male patient had resulted in several emergency department visits and hospitalization on one occasion. Anxiety was a predominant feature in the patients and their spouses that had interfered with their sexual life and worsened their disease. Late asthmatic response, on occasions, occurred in two patients. None of the patients developed wheezing dyspnea or rhinitis, nor did they have a fall in peak expiratory flow rates on climbing two flights of stairs, an exercise considered equivalent to energy expended during sexual intercourse. Thus, sexual excitement rather than exercise appeared to be the cause of postcoital asthma and rhinitis. Adequate pharmacotherapy along with counseling of the patients and their spouses restored normal sexual function and control of asthma and rhinitis. Postcoital asthma and rhinitis can easily be overlooked due to patient embarrassment and lack of physician awareness.