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Souza TMOD, Fernandes JS, Santana CVN, Lessa MM, Cruz ÁA. Aeroallergen sensitization patterns among patients with chronic rhinitis with or without concomitant asthma. Braz J Otorhinolaryngol 2024; 90:101351. [PMID: 38070373 PMCID: PMC10755714 DOI: 10.1016/j.bjorl.2023.101351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/20/2023] [Accepted: 10/02/2023] [Indexed: 01/01/2024] Open
Abstract
OBJECTIVES The aim of this study was to explore the differences in the pattern of allergen sensitization in CR individuals without or with asthma, according to asthma severity. METHODS A total of 1066 adults were evaluated. Asthma and chronic⁄allergic rhinits were identified by specialists, questionnaries and skin-prick test. The phenotypic characterization was avaliable from skin-prick test to an aeroallergen extended panel, total IgE and pulmonary function. Using questionnaires and clinical evaluation, participants were classified into the groups: chronic rhinitis alone (CRA) and chronic rhinitis + asthma, the latter subdivided into CR + mild asthma (CRMA) and CR + moderate to severe asthma (CRMSA). Aerollergen sensitization was defined by a positive prick test to one or more allergens associated with nasal symptoms and/or asthma. The association between CR and asthma was evaluated by multivariable logistic regression. The evidence of effect modification of pattern of sensitization in CR on the association with asthma severity and outcomes was examined by introducing interactions terms in the logistic regression models adjusting for confounders. RESULTS Frequency of sensitization to aeroallergens was higher in association with asthma in comparison to CRA (CRMA 70.4%; CRMSA 65.0%; CRA 47.0%; p = 0.000). Similarly, the presence of asthma was associated to aeroallergen multiple sensitization (51.5%) (OR = 2.10, 95% CI 1.27-3.50). Additionally, the sensitization to mites, cockroaches, animal epithelium, grasses, and molds, were higher in asthma (56.8%, 24.3%, 12%, 7.13% and 10.3%, respectively). Sensitization to Alternaria alternata, Cladosporium herbarum and dog epithelium was exclusive in asthma groups. A concomitant asthma diagnosis was directly associated with a positive allergen sensitization at least one allergen (62.7%, OR = 2.45, 95% CI 1.80-3.34) and polissensitization (51.5%, OR = 2.10, 95% CI 1.27-3.50). CONCLUSION Asthma is associated with multiple allergen sensitization among patients with CR. Some unique profiles of aeroallergen sensitization were observed in patients with CR and asthma. Nevertheless, no difference was found in the sensitization in relation to asthma severity, which suggest atopy is not the main underlying mechanism for asthma severity among patients with CR. LEVEL OF EVIDENCE Level 3.
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Reddy SG, Al-Asadi Z, Cui R, Lombardo D, Ramadan HH, Makary CA. Association of autoimmune disorders with chronic rhinosinusitis in adults. Am J Otolaryngol 2024; 45:104177. [PMID: 38113772 DOI: 10.1016/j.amjoto.2023.104177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Increasing evidence suggests that autoimmune disorders and their immunomodulating medications may increase the risk of rhinosinusitis compared to rhinitis. GOAL To investigate the association between autoimmune disorders and rhinosinusitis. METHODS We performed a case-control study of patients referred to West Virginia University from August 2020 to October 2022 for rhinologic complaints. Rhinosinusitis patients were diagnosed with either chronic rhinosinusitis (CRS) or recurrent acute rhinosinusitis (RARS). These patients were compared to non-rhinosinusitis patients. Patients' characteristics, comorbidities, and type of treatment of autoimmune disorders were reviewed. RESULTS The sample consisted of 527 rhinosinusitis [184 CRS without nasal polyps (CRSsNP), 263 CRS with nasal polyps (CRSwNP) and 80 RARS patients] patients and 564 non-rhinosinusitis patients. Patients with rhinosinusitis were more likely to be older, males, have asthma, and have current and past smoking history (all with p-value < 0.05). Autoimmune disorders, primary antibody deficiency, and immunomodulator agents were more common in rhinosinusitis patients (16.5 % vs 9.4 %, OR = 1.9, p < 0.001; 5.1 % vs 0.5 %, OR = 10.1, p < 0.001; and 3.8 % vs 1.1 %, OR = 3.7, p = 0.003 respectively). Multivariate logistic regression adjusting for confounders showed that autoimmune disorders were strongly associated with rhinosinusitis [OR = 1.6, 95 % CI = 1.10-2.48], whereas the immunomodulators did not reach statistical significance [OR = 2.4, 95 % CI = 0.87-6.47]. Subgroup analysis showed the autoimmune disorders did not significantly differ between CRS and RARS groups [OR = 1.0, 95 % CI = 0.5-2.1], or between the CRSsNP and CRSwNP groups [OR = 0.9, 95 % CI = 0.5-1.7]. CONCLUSION Autoimmune disorders are associated with rhinosinusitis, both CRS and RARS, independently of other risk factors.
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Affiliation(s)
- Sairisheel Gabbi Reddy
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
| | - Zayd Al-Asadi
- School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Ruifeng Cui
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
| | - Dominic Lombardo
- School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America.
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Fieux M, Carsuzaa F, Nourredine M, Alexandru M, Giroudon C, Bartier S, Legré M, Favier V, Fath L. Surgical and instrumental options for chronic rhinitis: A systematic review and PRISMA meta-analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:279-287. [PMID: 37867008 DOI: 10.1016/j.anorl.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND There is no consensus on the role of surgery in the treatment of chronic rhinitis (CR). Should it be considered when nasal symptoms are not controlled by medical treatment? Various targets (turbinates and secretory nerves) and techniques (surgical, laser, cryotherapy, radiofrequency and phototherapy) have been reported, but benefit varies between reports. The aim of this systematic review and meta-analysis was to evaluate results of surgical and instrumental procedures in CR care. METHODS Two systematic reviews of the US National Library of Medicine, Cochrane Library, Web of Science and Embase databases were conducted in October 15, 2021 (registration numbers CRD42021284257 and CRD42021295227). A database watch was performed until submission of the manuscript. The review focuses on total nasal symptom score (TNSS) and quality of life (QoL) after treatment. All controlled studies reporting nasal surgery/instrumental procedures in adult patients with CR were included. RESULTS The database search yielded a total of 5628 articles; after eligibility screening, 2091 patients were included from 21 studies. QoL results favored surgery/instrumental procedures over medical treatment (SMD -1.27; 95% CI [-2.38; -0.16]; I2=97%), as did TNSS (SMD -1.40; 95% CI [-2.30; -0.50]; I2=98%). The small number of studies and their heterogeneity did not allow meta-regression to be performed. CONCLUSION This systematic review supports the use of surgical/instrumental procedures to improve nasal symptom score and QoL of adult patients with CR poorly controlled by medical treatment.
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Affiliation(s)
- M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite cedex, France.
| | - F Carsuzaa
- Service ORL, chirurgie cervico-maxillo-faciale et audiophonologie, centre hospitalier universitaire de Poitiers, 86000 Poitiers, France
| | - M Nourredine
- Service de biostatistiques de Lyon, pôle santé publique, hospices civil de Lyon, Lyon, France
| | - M Alexandru
- Service d'ORL et chirurgie cervico-faciale, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Saclay, 78, rue du Général-Leclerc, 94270 le Kremlin-Bicêtre, France
| | - C Giroudon
- Service de la documentation centrale, hospices civils de Lyon, 69424 Lyon cedex, France
| | - S Bartier
- Service d'ORL, de chirurgie cervico-faciale, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France
| | - M Legré
- Service d'ORL et chirurgie cervico-faciale, institut Arthur-Vernes, Paris, France
| | - V Favier
- Département d'ORL, chirurgie cervico-faciale et maxillo-faciale, hôpital Gui-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - L Fath
- Service d'ORL, de chirurgie cervico-faciale, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France
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Le Normand F, Djennaoui I, Debry C, Fath L. Inferior turbinate lateralization. Eur Ann Otorhinolaryngol Head Neck Dis 2023:S1879-7296(23)00137-0. [PMID: 37872042 DOI: 10.1016/j.anorl.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Inferior turbinate lateralization via an endonasal approach is a reliable low-risk procedure to correct inferior turbinate hypertrophy resistant to medical treatment. This well-established technique provides nasal comfort while conserving the mucosal membrane and physiology of the inferior turbinate, minimizing the postoperative complications (empty nose syndrome) besetting turbinoplasty involving mucosal or submucosal reduction.
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Affiliation(s)
- F Le Normand
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67100 Strasbourg, France.
| | - I Djennaoui
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67100 Strasbourg, France
| | - C Debry
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67100 Strasbourg, France; Unité Inserm 1121, Biomatériaux et Bioingénierie, Centre de Recherche en Biomédecine de Strasbourg, 1, rue Eugène Boeckel, 67000 Strasbourg, France
| | - L Fath
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67100 Strasbourg, France; Unité Inserm 1121, Biomatériaux et Bioingénierie, Centre de Recherche en Biomédecine de Strasbourg, 1, rue Eugène Boeckel, 67000 Strasbourg, France
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Naletilić N, Pondeljak N, Lugović-Mihić L, Trkulja V, Kalogjera L. ASSOCIATION BETWEEN SYMPTOM SEVERITY AND INTENSITY OF ACUTE PSYCHOLOGICAL DISTRESS IN NEWLY DIAGNOSED PATIENTS WITH CHRONIC RHINITIS AND CHRONIC RHINOSINUSITIS. Acta Clin Croat 2023; 62:193-200. [PMID: 38304375 PMCID: PMC10829954 DOI: 10.20471/acc.2023.62.01.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/10/2022] [Indexed: 02/03/2024] Open
Abstract
Chronic rhinitis and rhinosinusitis (CR and CRS) can lead to impairment of the health-related quality of life (HRQL) with higher psychological perceived distress, resulting in disease worsening and poor treatment outcomes. W aimed to evaluate the potential association between disease severity and HRQL impairment with the perceived acute psychological distress in newly diagnosed CR/CRS patients. This single-center cross-sectional study included otherwise healthy consecutive adults with newly diagnosed CR/CRS (European position paper on rhinosinusitis and nasal polyp criteria and International Consensus Statement on Allergy and Rhinology - Allergic Rhinitis criteria or non-allergic rhinitis), who were evaluated for CR/CRS symptom severity and HRQL (Sino Nasal Outcome Test 22 [SNOT-22], visual analog scale [VAS]) and acute perceived distress (Perceived Stress Scale [PSS]). Principal component analysis (SNOT-22 items, VAS) identified 6 components as CR/CRS severity indicators, i.e,, poor sleep, wakes-up tired, nasopharynx, obstruction, torment and rhinorrhea, which were evaluated for association with PSS score. Of the 63 included patients (20 men, age median 38, range 19-75 years), 27 suffered from CR and 36 from CRS. Upon adjustment for age and sex, higher total SNOT-22 (geometric means ratio [GMR]=1.04, 95% CI 1.01-1.06), higher "torment" (GMR=1.13, 1.04-1.24), higher "poor sleep" (GMR=1.11, 1.02-1.21) and higher "wakes-up tired" (GMR=1.11, 1.01-1.21) scores were each associated with a higher PSS score, overall and consistently in CR and CRS patients. In conclusion, more severe CR/CRS is associated with greater perceived psychological distress already at earlier stages of the disease. Paying attention to patient level of distress and anxiety over time may enable better understanding of the connection between exacerbations, symptom severity and psychological burden of the disease.
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Affiliation(s)
- Nia Naletilić
- Department of Otorhinolaryngology-Head and Neck Surgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nives Pondeljak
- Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Liborija Lugović-Mihić
- Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vladimir Trkulja
- Department of Pharmacology, Zagreb University School of Medicine, Zagreb, Croatia
| | - Livije Kalogjera
- Department of Otorhinolaryngology-Head and Neck Surgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Saraswathula A, Yesantharao L, Gourin CG, Rowan NR, Frick KD. Cost-effectiveness analysis comparing in-office posterior nasal nerve ablation to surgical therapies. Am J Otolaryngol 2023; 44:103776. [PMID: 36586318 PMCID: PMC10033428 DOI: 10.1016/j.amjoto.2022.103776] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Recently, in-office posterior nasal nerve ablation (PNA) devices have offered a new tool to treat refractory chronic rhinitis, but their cost-effectiveness relative to traditional interventions such as vidian neurectomy (VN) and posterior nasal neurectomy (PNN) remains unexplored. OBJECTIVE To compare the cost-effectiveness of these interventions in patients with refractory chronic rhinitis. METHODS A decision tree with embedded Markov models was created to compare the cost-effectiveness of PNN, VN, and PNA, measured in quality-adjusted life years (QALYs) over a 30-year time horizon with a $100,000/QALY willingness-to-pay threshold. One- and two-way sensitivity analyses were completed. RESULTS Sensitivity analysis found that in-office PNA became cost-effective compared to VN when patients undergoing PNA were less than 20 % more likely than VN to have symptoms recur; this value was assumed to be twice as likely in the base case. In the base case, however, VN and in-office PNA were more effective and less expensive than PNN, while VN was cost-effective when compared to in-office PNA (incremental cost-effectiveness ratio $11,616.24/QALY). Other assumptions were not found to considerably impact incremental cost-effectiveness. CONCLUSION Although highly limited by currently available data, PNA may be cost-effective compared to VN as long-term outcomes on the durability of its effects emerge. These data should not be used by payers considering coverage or utilization since long-term data is still nascent. However, that as new technologies emerge for rhinitis, it will be important to monitor longer-term outcomes to identify high value care, but based on limited data PNA devices may meet this standard.
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Affiliation(s)
- Anirudh Saraswathula
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Lekha Yesantharao
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD, United States of America
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Kevin D Frick
- Carey Business School, Johns Hopkins University, Baltimore, MD, United States of America; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
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de la Hoz RE, Shohet MR. World Trade Center Health Program best practices for diagnosing and treating chronic rhinosinusitis. Arch Environ Occup Health 2023; 78:212-215. [PMID: 36660944 PMCID: PMC10353885 DOI: 10.1080/19338244.2023.2169655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
The most frequent adverse physical health effect among World Trade Center Health Program (WTCHP) members is chronic rhinosinusitis (CRS), with some evidence supporting its association with the exposures to dust, gases, and toxicants. We selected the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICARS-RS-2021) as a comprehensive evidence-based guide on best practices for CRS diagnosis and treatment for the WTCHP.
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Affiliation(s)
- Rafael E. de la Hoz
- Division of Occupational and Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael R. Shohet
- Department of Otolaryngology and Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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van Schie B, Vavrina JJ, Soyka MB. Progression of Rhinitis to Rhinosinusitis: A Cohort Study. ORL J Otorhinolaryngol Relat Spec 2022; 85:186-194. [PMID: 36574765 PMCID: PMC10534962 DOI: 10.1159/000527885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 10/26/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Chronic rhinitis (CR) and rhinosinusitis are prevalent conditions affecting people all over the world. Their exact relationship is still not fully understood. We sought to find out, whether CR is a risk factor for chronic rhinosinusitis (CRS) and which main subgroup or other factors could be predisposing. METHODS Patients with diagnosed CR between 2005 and 2010 were selected from the electronic medical record and were contacted by phone call. They were interviewed and screened for possible CRS using internationally approved questionnaires, e.g. NOSE-D and SNOT-20-GAV. Those with elevated scores were invited for a clinical examination. RESULTS Of 113 patients available for statistical analysis (48/65 = f/m), mean age of 52 ± 15 years, 13 patients were diagnosed with CRS. Extrapolated for the total cohort of 334, calculated prevalence was 9.5%. No statistical significantly higher probability of developing CRS for either main subgroup of CR was found. Age of onset, prior surgery of the nose, and use of topical nasal treatments were associated with the development of CRS in multivariate analyses (OR = 0.1, 3.2, and 3.2, respectively). DISCUSSION/CONCLUSIONS Only a small number of rhinitis patients developed CRS, questioning the paradigm of CR being a clear risk factor for CRS.
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Affiliation(s)
- Bram van Schie
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland,
| | - Joel J Vavrina
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Michael B Soyka
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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De Corso E, Seccia V, Ottaviano G, Cantone E, Lucidi D, Settimi S, Di Cesare T, Galli J. Clinical Evidence of Type 2 Inflammation in Non-allergic Rhinitis with Eosinophilia Syndrome: a Systematic Review. Curr Allergy Asthma Rep 2022. [PMID: 35141844 DOI: 10.1007/s11882-022-01027-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Non-allergic rhinitis (NAR) includes different subtypes, among which NAR with eosinophilia syndrome (NARES) is the most important because of severity of symptoms and the high risk of comorbidities. Its pathophysiology is still object of debate, but a crucial role of chronic eosinophilic inflammation has been recognized. The aim of this review is to critically analyze the current evidence regarding the hypothesis that NARES may be considered a type 2 inflammatory disorder. RECENT FINDINGS The definition and diagnostic criteria for NARES are not universally shared and adopted, thus generating difficulties in reproducing the results. At present, there is extreme heterogeneity in sampling methods and disagreement in the cut-off of local eosinophilic count to determine a diagnosis of NARES. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standard was applied to identify English-language experimental and clinical articles regarding NARES. The search was performed in April 2021. Twenty-six articles were included. Our data suggest a particular heterogeneity regarding sampling and specific cut-offs adopted for diagnosis of NARES and consensus should be reached. We suggest that eosinophil count should be reported as an absolute value for at least 10 observed rich fields in order to increase the level of standardization. Consensus among authors on this topic should be reached with particular attention to the cut-off for diagnosis. In the future, this limitation may be overcome by the identification of repeatable biomarkers to refine diagnosis and prognosis of NARES. Furthermore, our data strongly suggest that NARES have numerous similarities with clinical features of the most common type 2 diseases such as eosinophilic asthma and chronic rhinosinusitis with nasal polyps (CRSwNP): late onset, association with type 2 comorbidities, selective eosinophilic tissue infiltration, remarkable response to oral and intranasal corticosteroids, and progression in a type 2 CRSwNP.
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Xu X, Qin L, Ren L, Wang C, Zhang Y, Zhang L. Comparative analysis of chronic rhinitis patient profiles during autumn pollen season between grassland and non-grassland cities in North China. Allergy Asthma Clin Immunol 2021; 17:106. [PMID: 34635159 PMCID: PMC8503993 DOI: 10.1186/s13223-021-00591-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background The symptoms of patients with respiratory disease are influenced by local environmental factors. The incidence of allergic rhinitis in grassland areas was significantly higher than that in non-grassland areas. We aimed to compare the profiles of chronic rhinitis patients obtained during the autumn pollen season in Baotou (grassland city) and Beijing (non-grassland city), China. Methods Questionnaire surveys and allergen testing were conducted on 1170 and 1232 patients with chronic rhinitis visiting the Second Affiliated Hospital of Baotou Medical College and Beijing Tongren Hospital, respectively, during the autumn pollen period. Information regarding medical history, severity of symptoms, and diagnosis and treatment was collected. Results More patients with moderate to severe chronic rhinitis and asthma (both, P < 0.001) were present in Baotou than in Beijing. Mugwort was the most abundant allergen in both regions, but the number of patients sensitized to outdoor allergens in Baotou was higher than that in Beijing (P < 0.001). Indoor allergens in Beijing represented a considerable proportion of allergens, especially dust mites (33.4%). For patients with allergic rhinitis, nasal congestion, nasal itching, and runny nose were more severe in Baotou than in Beijing (P < 0.001). In both Baotou and Beijing, allergy (P < 0.001 vs. P = 0.004) and combined asthma (P = 0.049 vs. P = 0.005) were common factors affecting the severity of the clinical symptoms chronic rhinitis. In Baotou, age (rs = 0.195, P < 0.001) and family allergy history (P = 0.010) were also associated with symptom severity. Although significantly more patients in Baotou received oral antihistamines, nasal corticosteroids, and surgical treatment than in Beijing (P < 0.001), the number of people receiving allergy immunotherapy in Baotou was lower (P = 0.004) and post-treatment symptom control was worse (P < 0.001) that that in Beijing. Conclusions During the pollen period, there were significant differences in the allergen spectrum between Baotou and Beijing. Allergy and combined asthma were common factors affecting the severity of clinical symptoms. Patients in Baotou presented with more severe clinical symptoms that were not satisfactorily managed due to the impact of pollen exposure, inconsistent access to care, and differing treatment modalities. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-021-00591-w.
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Affiliation(s)
- Xu Xu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, No. 17, Hou Gou Hu Tong, Dong Cheng District, 100005, Beijing, People's Republic of China.,Department of Allergy, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China
| | - Long Qin
- The Second Affiliated Hospital of Baotou Medical College, Baotou Medical College, Baotou, China
| | - Lei Ren
- Department of Allergy, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, No. 17, Hou Gou Hu Tong, Dong Cheng District, 100005, Beijing, People's Republic of China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China. .,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, No. 17, Hou Gou Hu Tong, Dong Cheng District, 100005, Beijing, People's Republic of China. .,Department of Allergy, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China.
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China. .,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, No. 17, Hou Gou Hu Tong, Dong Cheng District, 100005, Beijing, People's Republic of China. .,Department of Allergy, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China.
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Joy N, Jacob J, Kurien R, Varghese L, Rabi S, Rupa V. Effect of Silver Nitrate Cauterisation of Nasal Mucosa on Quality-of-Life and Histology in Patients with Intractable Chronic Rhinitis. Indian J Otolaryngol Head Neck Surg 2021; 74:1615-1622. [PMID: 34336632 PMCID: PMC8316537 DOI: 10.1007/s12070-021-02773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/18/2021] [Indexed: 11/24/2022] Open
Abstract
Patients with chronic rhinitis causing intractable sneezing which is non-responsive to conventional medication require alternative therapies. The aim of the study was to ascertain the effect of topical 10% silver nitrate solution on the inferior turbinate mucosa as well as quality of life in such patients. Patients with severe chronic rhinitis who failed conventional therapy had application of 10% silver nitrate solution to inferior turbinate mucosa. The number of sneezes/day and mini Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score was noted before and 8 to 16 weeks after treatment. Pre- and post treatment turbinate biopsies were performed to assess histological changes. At baseline, 67 patients had a mean of 36.6 sneezes/day and mean mini RQLQ score of 4.0 ± 0.7. Pre-treatment biopsies showed epithelial denudation and hyalinization of basement membrane. Following 10% silver nitrate application, 64/67 (95.5%) patients showed significant reduction in number of sneezes both at 1 week (p < 0.001) and 8-16 weeks (mean = 5.5 ± 7.8; p < 0.001). Post- treatment mean global mini RQLQ score was also significantly reduced (mean = 1.3 ± 1.1; p < 0.001). A single application was sufficient in 70.1% patients. There were no complications. Squamous metaplasia (p = 0.005) and epithelial hyperplasia (p = 0.013) as well as epithelial and basement membrane restoration occurred following therapy. 10% silver nitrate solution application is an effective and safe office- based procedure which significantly reduces sneezing improves QoL with corresponding histological changes.
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Affiliation(s)
- Nedha Joy
- Departments of Otorhinolaryngology, Christian Medical College, Vellore, 632004 India
| | - Jenny Jacob
- Departments of Anatomy, Christian Medical College, Vellore, India
| | - Regi Kurien
- Departments of Otorhinolaryngology, Christian Medical College, Vellore, 632004 India
| | - Lalee Varghese
- Departments of Otorhinolaryngology, Christian Medical College, Vellore, 632004 India
| | - Suganthy Rabi
- Departments of Anatomy, Christian Medical College, Vellore, India
| | - V Rupa
- Departments of Otorhinolaryngology, Christian Medical College, Vellore, 632004 India
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Lu M, Yang H, Wang J, An Z, Li J, Wu Z, Zhao Q, Li H, Zhai D, Liu Y, Wu W, Song J. Acute effects of ambient air pollution on outpatients with chronic rhinitis in Xinxiang, China. Environ Sci Pollut Res Int 2021; 28:9889-9897. [PMID: 33159228 DOI: 10.1007/s11356-020-11534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
Air pollution exposure leads to increased mortality and morbidity rates of respiratory diseases. Most of the evidence was founded on acute diseases such as acute lower respiratory diseases. However, limited studies have been conducted to evaluate the effects of air pollution on chronic respiratory diseases. This time-series study was conducted to examine the acute effects of 6 criteria ambient air pollutants on hospital outpatients with chronic rhinitis (CR) in Xinxiang, China. We retrieved 223,826 outpatient records of patients with respiratory diseases, of which 62,901 were those of patients with CR. Results showed that the current 10-μg/m3 increase in fine particulate matter (PM2.5), inhalable particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) corresponds to 0.67% (95% confidence interval [CI]: 0.15-1.18%), 0.58% (95% CI: 0.24-0.92%), 1.89% (95% CI: 0.52-3.27%), 3.01% (95% CI: 1.66-4.35%), and 0.06% (95% CI: 0.03-0.10%) increments in outpatients with CR, respectively. In addition, the effects in the male were stronger than those in the female. Higher effect estimates were observed in the old (≥ 65 years of age) and younger (< 15 years of age) groups. Our study confirmed the association between air pollution and outpatients with CR in Xinxiang, China. More stringent air pollution control measures must be implemented.
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Affiliation(s)
- Mengxue Lu
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Huijuan Yang
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Jingyao Wang
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Zhen An
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Juan Li
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Zhineng Wu
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Qian Zhao
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Huijun Li
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Desheng Zhai
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Yue Liu
- Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing, 100021, China
| | - Weidong Wu
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Jie Song
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China.
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13
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Patel GB, Kern RC, Bernstein JA, Hae-Sim P, Peters AT. Current and Future Treatments of Rhinitis and Sinusitis. J Allergy Clin Immunol Pract 2020; 8:1522-1531. [PMID: 32004747 DOI: 10.1016/j.jaip.2020.01.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 02/07/2023]
Abstract
Advances in understanding the pathogenic mechanisms of both rhinitis and chronic rhinosinusitis have resulted in new treatment options, especially for chronic rhinosinusitis. A review of relevant medical and surgical clinical studies shows that intranasal corticosteroids, antihistamines, and allergen immunotherapy continue to be the best treatments for chronic rhinitis. Dupilumab is the first biologic approved for chronic rhinosinusitis with polyps. Omalizumab, mepolizumab, and benralizumab may have a future role in the treatment of chronic rhinosinusitis. Novel corticosteroid delivery devices such as an exhalation delivery system for fluticasone and bioabsorbable sinus implants provide enhanced and localized distribution of corticosteroids. Surgical management tailored to the underlying disease process improves clinical outcomes in chronic rhinosinusitis with or without nasal polyposis. Advances in the understanding of the heterogeneous nature of rhinitis and rhinosinusitis have resulted in more precise treatments. Improving the understanding of different endotypes should provide better knowledge to determine appropriate current and new therapies to treat these diseases.
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Affiliation(s)
- Gayatri B Patel
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Park Hae-Sim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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14
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Mourad A, Jaffal H, El-Hakim I, El-Hakim H. The impact of bilateral endoscopic inferior turbinoplasty with or without adenoidectomy on the quality of life of children: a retrospective case series study. J Otolaryngol Head Neck Surg 2019; 48:68. [PMID: 31791402 PMCID: PMC6888903 DOI: 10.1186/s40463-019-0390-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/19/2019] [Indexed: 11/27/2022] Open
Abstract
Background Inferior turbinoplasty (IT) and adenoidectomy (Ad) are frequently resorted to in children with chronic rhinitis (CR) refractory to medical therapy. The aim of this study is to document the long-term improvement in quality of life (QOL) in children with CR following endoscopic IT with or without Ad. Methods A retrospective case series study was conducted. We searched a prospectively kept surgical database for children ≤18 years old who had CR who underwent endoscopic IT with or without Ad between 2009 and 2016 at a tertiary care children’s center. Patients with sinonasal pathologies other than CR, had craniofacial syndromes or dysmorphism and had other sinonasal procedures or trauma were excluded. Collected data included demographics, secondary diagnoses, duration of follow-up, and complications of procedures. The Glasgow Children’s Benefit Inventory (GCBI) was administered by phone to assess QOL improvement. Results One hundred sixty-five eligible subjects were identified. Eighty-nine subjects met the inclusion criteria. Data was collected for the 60 subjects that were reached. Forty-two patients had IT only while 18 had IT and Ad. The mean age was 10.7 ± 2.7 years, with 31 males and 29 females. The median duration of follow-up (25th, 75th percentile) was 38.1 months (24.6, 55.8). The median GCBI score (25th, 75th percentile) was 22.9 (6.3, 39.6) revealing an overall positive benefit in all domains. There was only one complication. Conclusions This study validates prior findings regarding improvement of QOL and safety of IT with or without Ad for children with CR and indicates it is maintained in the long term.
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Affiliation(s)
- Ahmed Mourad
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hussein Jaffal
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, The Stollery Children's Hospital and University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Ismaeel El-Hakim
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, The Stollery Children's Hospital and University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, The Stollery Children's Hospital and University of Alberta Hospital, Edmonton, Alberta, Canada. .,Divisions of Otolaryngology - Head & Neck Surgery and Pediatric Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital and University of Alberta Hospital, Edmonton, Alberta, Canada.
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15
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Hounkpatin SHR, Flatin MC, Bouraima AF, Amegan HN, Toukourou Adios MAF, Adjibabi W. Rhinologic signs associated with snuff taking. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:43-45. [PMID: 31699623 DOI: 10.1016/j.anorl.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study rhinologic signs associated with nasal tobacco (snuff) intake in Parakou, northern Benin. MATERIALS AND METHODS A cross-sectional descriptive comparative study included 300 tobacco snuff takers and 300 subjects who did not use tobacco at all. The sampling technique was a stratified 4-stage random sample for non-users and a convenience non-random sample for snuff takers. RESULTS The sex-ratio was 0.92 in non-users and 41.9 in snuff takers. Duration of snuff taking was more than 20 years in 24.3% of cases. The symptoms studied were significantly more frequent in snuff takers than non-users (P<0.05). Snoring was reported by 58.3% of snuff takers, versus 5.7% of non-users (P=0.000). Nasal obstruction and rhinorrhea were reported by respectively 26.3% and 22.7% of snuff takers, versus 6.3% and 5.3% of non-users (P=0.000). Hyposmia was reported by 14% of snuff takers, versus 1.3% of non-users (P=0.000). Anterior rhinoscopy found abnormalities in 81.7% of snuff takers, compared to 10.67% of non-users. Nasal hypertrichosis was more frequent in snuff takers than non-users: 40% versus 5% (P=0.000). CONCLUSION Nasal intake of tobacco is responsible for morbidity in snuff takers compared to non-users of tobacco.
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Affiliation(s)
| | - M C Flatin
- Faculté de médecine de l'Université de Parakou, Parakou, Benin
| | - A F Bouraima
- Faculté de médecine de l'Université de Parakou, Parakou, Benin
| | - H N Amegan
- Faculté des sciences de la Santé de l'Université d'Abomey-Calavi, Cotonou, Benin
| | | | - W Adjibabi
- Faculté des sciences de la Santé de l'Université d'Abomey-Calavi, Cotonou, Benin
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16
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Singh U, Wangia-Anderson V, Bernstein JA. Chronic Rhinitis Is a High-Risk Comorbidity for 30-Day Hospital Readmission of Patients with Asthma and Chronic Obstructive Pulmonary Disease. J Allergy Clin Immunol Pract 2018; 7:279-285.e6. [PMID: 30053594 DOI: 10.1016/j.jaip.2018.06.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/21/2018] [Accepted: 06/28/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Early hospital readmissions for asthma and chronic obstructive pulmonary disease (COPD), measured as hospital readmission within 30 days from the last discharge, is a major economic burden to our health care system. The association of this measure with comorbid chronic rhinitis (CR) has not been investigated before despite significant clinical association between CR and asthma or COPD. OBJECTIVE To investigate the association of CR with the risk of asthma or COPD-related early hospital readmission rates. METHODS This retrospective cohort study was performed using the asthma- and COPD-related hospital encounter and patient comorbidity data between June 15, 2012, and July 19, 2017, from a large hospital care system in Cincinnati, Ohio. Patients (any sex, race or socioeconomic status, and of all ages) with a primary discharge diagnosis of asthma (n = 4754 patients, 10,111 encounters) and COPD (n = 2176 patients, 4748 encounters) based on International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were included. Relevant comorbidities, including comorbid allergic rhinitis (AR) or nonallergic rhinitis (NAR), in such patients were identified using ICD-10-CM codes. The association between 30-day asthma or COPD-related hospital readmission (1670 such encounters for asthma and 736 for COPD) and comorbid CR in the affected patients were determined using Cox proportional hazards models. Multivariate-adjusted hazard ratios (HRs), adjusted for relevant patient comorbidities, compared 30-day asthma- and COPD-related readmissions of patients with CR with those patients without a CR diagnosis. RESULTS Analysis was performed on 4754 patients with asthma and 2176 patients with COPD. The median follow-up period (+interquartile range) for asthma was 980 (+760) days and for COPD was 553 (+827) days. The HRs for 30-day asthma- or COPD-related readmission rates were significantly higher in patients with AR (HR = 4.4 [3.9, 5.0] and 2.4 [1.7, 3.2], respectively) or NAR (HR = 3.7 [2.9, 4.9] and 2.6 [1.8, 3.7], respectively) compared with patients without rhinitis. For asthma, both AR and NAR had higher HRs compared with all other comorbidities analyzed. For COPD, both AR and NAR had HRs to the magnitude as obesity and hypertension. CONCLUSIONS Comorbid CR is significantly associated with 30-day asthma- and COPD-related readmissions. These findings are useful for guiding health care professionals to focus on outpatient management of both the upper and lower respiratory tracts to reduce early readmission of patients with asthma and COPD.
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Affiliation(s)
- Umesh Singh
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Victoria Wangia-Anderson
- Clin & Health Info Sci, University of Cincinnati College of Allied Health Sciences, Cincinnati, Ohio
| | - Jonathan A Bernstein
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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17
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Abstract
The clinical distinction of chronic respiratory rhinitis appears to confirm the evo-devo theory of the three noses. The authors report two cases of advanced allergic rhinitis, in which chronic inflammation had induced a violaceous colour of the mucosa of the respiratory nose and a whitish polypoid appearance of the free edge of the middle turbinate. Nose and paranasal sinus CT scan revealed, beyond the virtual nasal cavities observed on nasal endoscopy and CT imaging, normal radiolucency or only minor opacities of the ethmoid (i.e. olfactory nose) and paranasal sinuses that could not explain the severity of the chronic nasal dysfunction. The hypothesis of non-allergic chronic respiratory rhinitis is developed according to these two observations. The differential diagnosis between chronic respiratory rhinitis and dysfunction of the cavernous plexuses of the respiratory nose is discussed. A precise diagnosis appears to be a prerequisite for appropriate and effective management. Surgery of the respiratory nose can associate septoplasty to inferior turbinoplasty, but must be preceded and combined with medical treatment adapted to the underlying inflammatory process.
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Affiliation(s)
- R Jankowski
- Service d'ORL et Chirurgie Cervico-Faciale, CHRU de Nancy, Hôpitaux de Brabois, Bât Louis Mathieu, Rue du Morvan, 54500 Vandoeuvre les Nancy, France
| | - P Gallet
- Service d'ORL et Chirurgie Cervico-Faciale, CHRU de Nancy, Hôpitaux de Brabois, Bât Louis Mathieu, Rue du Morvan, 54500 Vandoeuvre les Nancy, France
| | - D T Nguyen
- Service d'ORL et Chirurgie Cervico-Faciale, CHRU de Nancy, Hôpitaux de Brabois, Bât Louis Mathieu, Rue du Morvan, 54500 Vandoeuvre les Nancy, France.
| | - C Rumeau
- Service d'ORL et Chirurgie Cervico-Faciale, CHRU de Nancy, Hôpitaux de Brabois, Bât Louis Mathieu, Rue du Morvan, 54500 Vandoeuvre les Nancy, France
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18
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Caruso AA, Del Prete S, Ferrara L, Serra R, Telesca DA, Ruggiero S, Russo T, Sivero L. Relationship between gastroesophageal reflux disease and Ph nose and salivary: proposal of a simple method outpatient in patients adults. Open Med (Wars) 2016; 11:381-386. [PMID: 28352824 PMCID: PMC5329856 DOI: 10.1515/med-2016-0069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/23/2016] [Indexed: 12/15/2022] Open
Abstract
Introduction The frequency of gastroesophageal reflux disease (GERD) is increasing, in part through easy inspection of the upper digestive tract, but especially for a real spread of the disease as a consequence of modernity, lifestyle, incorrect dietary rules, and stress arising from social norms. It is a common chronic gastrointestinal disorder in Europe and the United States. Materials and methods The aim of our study is to highlight a relationship between gastroesophageal reflux disease and salivary pH as evidenced by indicator strips, especially in the outpatient field. Twenty adult subjects (10 males and 10 females) aged between 18 and 50 years (GROUP A)_ were selected. How to control a homogeneous group of 20 patients without GERD, or from any type of allergies (GROUP B) was enlisted. Results This method has provided excellent results showing no difference in the measured values compared with the traditional instrumental measurement. Conclusion Our study has allowed us to observe a strong correlation between the saliva pH, nasal cavities and the interaction between the two districts, and could be the basis for a diagnosis of GERD especially in primary health care clinics and in the initial stage of the disease.
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Affiliation(s)
| | - Salvatore Del Prete
- Department of Head and Neck. University of Naples Federico II, Naples, Italy
| | - Lydia Ferrara
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | | | - Simona Ruggiero
- Department of Advanced Biomedical Sciences. University of Naples Federico II, Naples, Italy
| | - Teresa Russo
- Department of Advanced Biomedical Sciences. University of Naples Federico II, Naples, Italy
| | - Luigi Sivero
- Department of Advanced Biomedical Sciences, University Federico II of Naples. School of Medicine, Naples, Italy, Via Sergio Pansini 5, 80131, Napoli.,Department of Advanced Biomedical Sciences. University of Naples Federico II, Naples, Italy
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Lara-Sánchez H, Álvarez Nuño C, Gil-Carcedo Sañudo E, Mayo Iscar A, Vallejo Valdezate LÁ. Assessment of nasal obstruction with rhinomanometry and subjective scales and outcomes of surgical and medical treatment. Acta Otorrinolaringol Esp 2016; 68:145-150. [PMID: 27780551 DOI: 10.1016/j.otorri.2016.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Prospective study of patients with nasal obstruction (NO) in order to measure therapeutic success by anterior active rhinomanometry (AAR), Nasal Obstruction Symptom Evaluation (NOSE) scale and Visual Analogue Scale (VAS) and to establish the correlation between these tests. METHODS Patients with NO, on whom we performed an AAR, NOSE and VAS scales at baseline and after medical treatment (topical nasal steroid) or surgery (septoplasty, turbinoplasty or septoplasty and turbinoplasty). The nasal flow obtained by the AAR and the score of both subjective scales (NOSE and VAS) were compared and analyzed. RESULTS A total of 102 patients were included in the study. Surgical treatment resulted in statistically significant differences with the AAR and the subjective scales. While in patients with medical treatment there was an increase in the AAR nasal flow but without statistical significance (P=.1363). The correlation between the AAR, the NOSE and VAS scales was measured finding a strong correlation between the NOSE and VAS scales only (r=.83327). CONCLUSIONS The patients with NO treated surgically have better results when these are evaluated by AAR or with subjective scales. There is no significant correlation between AAR, NOSE and VAS scales, this is considered to be because the AAR and subjective scales are complementary and measure different aspects of NO. The AAR and subjective scales are useful tools to be used together for the follow up of patients with NO.
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Affiliation(s)
- Hugo Lara-Sánchez
- Servicio de Otorrinolaringología, Hospital Universitario Río Hortega, Valladolid, España.
| | - Candelas Álvarez Nuño
- Servicio de Otorrinolaringología, Hospital Universitario Río Hortega, Valladolid, España
| | | | - Agustín Mayo Iscar
- Departamento de Estadística e Investigación Operativa, Universidad de Valladolid, Valladolid, España
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Abstract
Conditions such as chronic rhinitis, urticaria, angioedema, and asthma are frequently seen in clinics and hospitals, and there are a core group of medications that are often used to treat these conditions. Knowing the indications, optimal dosing, and side-effect profile of these medications can improve outcomes. Chronic rhinitis due to various causes is one of the most common reasons for primary care physician visits. Knowing the indications for use, forms of administration, and side-effect profiles of these medications can help improve patient outcomes in these common conditions. This review focuses on the medications used to treat these conditions.
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Affiliation(s)
- Andrew G Ayars
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA 98195, USA; Center for Allergy and Inflammation, UW Medicine at South Lake Union, 750 Republican Street, Box 358061, Seattle, WA 98109-4725, USA.
| | - Matthew C Altman
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA 98195, USA; Center for Allergy and Inflammation, UW Medicine at South Lake Union, 750 Republican Street, Box 358061, Seattle, WA 98109-4725, USA
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21
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Derendorf H, Meltzer EO, Hermann R, Canonica GW. Clinical development of an advanced intranasal delivery system of azelastine hydrochloride and fluticasone propionate. Drugs Today (Barc) 2014; 50:15-31. [PMID: 24524103 DOI: 10.1358/dot.2014.50.1.2094806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is no shortage of pharmacologic treatments available for the management of allergic rhinitis (AR), but none regularly provide full relief from all symptoms. MP29-02 (Dymista®) is a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP), benefiting from an enhanced formulation and improved device characteristics compared to marketed intranasal corticosteroid (INS) formulations. Results from large, randomized, double-blind, placebo-controlled, head-to-head trials versus first-line therapies, confirmed MP29-02 as the evidence-based drug-of-choice for AR treatment. MP29-02 was twice as effective as AZE or FP for nasal and ocular symptom relief in moderate to severe seasonal AR patients, with superiority documented regardless of season, and in more severe patients. More MP29-02-treated patients experienced clinically relevant responses (i.e., halving of nasal symptom burden and complete/near-to-complete relief) days faster than those on INS or intranasal antihistamine monotherapy. MP29-02's efficacy was sustained long-term versus FP (up to 52 weeks) in chronic rhinitis patients (perennial AR or nonallergic rhinitis), with 7 out of 10 patients first becoming symptom-free following 1 month's treatment with MP29-02, and days faster than with the INS. These results confirm MP29-02's superiority over the historical gold-standard therapy for AR (i.e., INS), and position it now as first-line treatment for moderate to severe AR patients, the majority of whom are uncontrolled on existing medications.
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Affiliation(s)
- H Derendorf
- College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - E O Meltzer
- Allergy and Asthma Medical Group and Research Center, San Diego, California, USA
| | - R Hermann
- Clinical Research Appliance, Gelnhausen, Germany
| | - G W Canonica
- University of Genova, IRCCS AOU S. Martino, Genoa, Italy.
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22
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Berger WE, Shah S, Lieberman P, Hadley J, Price D, Munzel U, Bhatia S. Long-term, randomized safety study of MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in an advanced delivery system) in subjects with chronic rhinitis. J Allergy Clin Immunol Pract 2014; 2:179-85. [PMID: 24607046 DOI: 10.1016/j.jaip.2013.09.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND MP29-02 is a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate (FP) in an advanced delivery system for the treatment of seasonal allergic rhinitis. OBJECTIVE The objective of this study was to evaluate the long-term safety of MP29-02 in subjects with chronic allergic (perennial) or nonallergic (vasomotor) rhinitis. METHODS This was a 1-year, randomized, open-label, active-controlled, parallel-group study in subjects with chronic allergic or nonallergic rhinitis. A total of 612 subjects were randomized in a 2:1 ratio to (1) MP29-02, one spray per nostril twice daily (total daily doses of azelastine hydrochloride and FP were 548 mcg and 200 mcg, respectively); or (2) FP, 2 sprays per nostril once daily (total daily dose 200 mcg). Safety and tolerability assessments were made at months 1, 3, 6, 9, and 12. RESULTS The incidence of treatment-related adverse events was low with both MP29-02 (9.4%) and FP (11.1%), with no evidence of late-occurring adverse events. Nasal examinations showed no evidence of nasal mucosal ulcerations or septal perforations with MP29-02, and the overall incidence of adverse findings was reduced as the study progressed. There were no unusual or unexpected ocular examination findings and no clinically important laboratory findings or clinically important differences between groups in fasting AM serum cortisol levels after 12 months of treatment. CONCLUSIONS MP29-02 was well tolerated. There were no safety findings that would preclude the long-term use of MP29-02 in the treatment of allergic rhinitis.
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Callea M, Teggi R, Yavuz I, Tadini G, Priolo M, Crovella S, Clarich G, Grasso DL. Ear nose throat manifestations in hypoidrotic ectodermal dysplasia. Int J Pediatr Otorhinolaryngol 2013; 77:1801-4. [PMID: 24080322 DOI: 10.1016/j.ijporl.2013.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/31/2013] [Accepted: 09/04/2013] [Indexed: 11/28/2022]
Abstract
The ectodermal dysplasias (EDs) are a large and complex group of inherited disorders. In various combinations, they all share anomalies in ectodermal derived structures: hair, teeth, nails and sweat gland function. Clinical overlap is present among EDs. Few causative genes have been identified, to date. Altered gene expression is not limited to the ectoderm but a concomitant effect on developing mesenchymal structures, with modification of ectodermal-mesenchymal signaling, takes place. The two major categories of ED include the hidrotic and hypohidrotic form, the latter more frequent; they differentiate each other for the presence or absence of sweat glands. We report Ear Nose Throat manifestations of ED, linked to the reduction of mucous glands in the nasal fossae with reduced ciliar function, and decrease salivary glands function. Often patients report an increased rate of infections of the upper respiratory tract and of the ear. Nasal obstruction due to the presence of nasal crusting, hearing loss and throat hoarseness are the most represented symptoms. Environmental measures, including a correct air temperature and humidification, is mandatory above all in subjects affected by hypohidrotic form.
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Affiliation(s)
- Michele Callea
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
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