Allergic Rhinosinusitis Research Articles

PARTICULARITIES IN THE CHILD CHRONIC RHINOSINUSITIS

Chronic rhinosinusitis is a rare pathology in pediatric pathology versus adult patients. Clinical manifestations are related, on the one hand, with the anatomical particularities and, on the other hand, with the immune response correlated with the age of the child. Allergy is the main cause in 50% of child rhinitis, 40% of them debuting early until the age of 6 years. The clinical expression of allergic rhinosinusitis in children can sometimes be accompanied by comorbidity manifestations or complications. Impaired mucociliary clearance can be induced by other rare pathological situations that produce mucus rheology modification, as in cystic fibrosis (CF). Through, the clinical heterogenicity of expression is in relation, on the one hand, with immunogenic response and anatomical particularities relative to age of the child, and secondly with the diversity of inducing factors (from very frequent like allergy to the least frequent, CF). It requires a correct diagnosis, early and appropriate treatment by a multidisciplinary team collaboration.

Invasive Rhinosinusitis due to Alternaria alternata and Rhizopus arrhizus Mixed Infection: A Case Report and Review

Introduction: Rhizopuse Sp. are common infectious agents of invasive rhinosinusitis. Though Alternaria is known to cause allergic rhinosinusitis, invasive sinusitis because of Alternaria Sp. is rare. Coinfections with bacteria and fungus causing rhinosinusitis have been reported as have the Rhizopus infection with other fungus such as Aspergillus, Candida, and Exserohillum. However Rhizopus coinfection with Alternaria has not been reported to the best of our knowledge. Case Presentation: A sixty-year- old woman was admitted with periorbital pain, swelling and complete restriction of movement of her right eye. She had diabetes mellitus for fifteen years. Diagnosis of invasive sinusitis was confirmed by hyperintensities in her right maxillary and bilateral ethmoid sinuses on the MRI on her brain and demonstration of hyphal forms from sinus mucosa. Culture confirmed the presence of Alternariaalternata and Rhizopus arrhizus. Patient responded to treatment with Amphotercin B and had complete resolution. Conclusions: Co-infection with bacteria and mixed fungal infection should be looked for as treatment strategies may differ with different organisms. Presumptive treatment should include agents, which can cover the broadest possible range of organism known to cause invasive sinusitis.

Predicting revision sinus surgery in allergic fungal and eosinophilic mucin chronic rhinosinusitis.

Chronic rhinosinusitis consists of several disease processes. Eosinophilic mucin is found in the subtypes of allergic fungal sinusitis (AFS) and eosinophilic mucin chronic rhinosinusitis (EMCRS). These entities frequently require surgical intervention and have high recurrence rates. We aimed to determine factors in patients with AFS and EMCRS that may be associated with a higher rate of revision surgeries. Our hypothesis is that patients who have polyps, high Lund-Mackay score (LMS), and fungus may have higher revision rates. Retrospective cohort study. This is a retrospective analysis of 117 patients identified over a 5-year period (2005-2009) with the diagnosis of AFS or EMCRS. Contingency tables were created to obtain the odds ratios estimates, and 95% confidence intervals were used to access the association between the outcome (having revision surgery or not) and other clinical binary predictors. Twenty-six of 117 (22%) of the study patients underwent revision surgery. Within the 2-year follow-up period, an additional five of 26 (19%) required another revision surgery. Average LMS was slightly higher in those who underwent revision surgery (16 vs. 13) on a scale of 0 to 24, with an overall mean score of 18 and standard deviation of 6.82 for the whole sample (117). Other factors evaluated were the presence of fungus, polyps, eosinophilic mucin, and the eosinophilic count and medical therapy received. The presence of eosinophilic mucin was significantly associated a higher rate of revision surgery. 4. Laryngoscope, 127:59-63, 2017.

A Recently Established Murine Model of Nasal Polyps Demonstrates Activation of B Cells, as Occurs in Human Nasal Polyps.

Animal model systems are invaluable for examining human diseases. Our laboratory recently established a mouse model of nasal polyps (NPs) and investigated similarities and differences between this mouse model and human NPs. We especially focus on the hypothesis that B cell activation occurs during NP generation in the murine model. After induction of ovalbumin-induced allergic rhinosinusitis, 6% ovalbumin and Staphylococcus aureus enterotoxin B (10 ng) were instilled into the nasal cavity of mice three times per week for 8 weeks. The development of structures that somewhat resemble NPs (which we will refer to as NPs) was confirmed by hematoxylin and eosin staining. The mRNA and protein levels of various inflammatory cell markers and mediators were measured by real-time PCR in nasal tissue and by ELISA in nasal lavage fluid (NLF), respectively. Total Ig isotype levels in NLF were also quantitated using the Mouse Ig Isotyping Multiplex kit (EMD Millipore, Billerica, MA) on a Luminex 200 instrument (Life Technologies, Grand Island, NY). Similar to human NPs, there were significant increases in gene expression of inflammatory cell markers, such as CD19, CD138, CD11c, and mast cell protease-6 in nasal tissue samples of the NP group compared with those of the control group. In further investigations of B cell activation, mRNA expressions of B cell activating factor and a proliferation-inducing ligand were found to be significantly increased in mouse NP tissue. B cell-activating factor protein concentration and IgA and IgG1 levels in NLF were significantly higher in the NP group compared with the control group. In this study, the NP mouse model demonstrated enhanced B cell responses, which are reminiscent of B cell responses in human NPs.

Rhinovirus infection in murine chronic allergic rhinosinusitis model

Patients with chronic rhinosinusitis (CRS) commonly experience aggravation of their symptoms after viral upper respiratory infection (URI). Rhinovirus (RV) is the most common URI-causing virus. However, there is a lack of a mouse model of RV infection and in vivo studies investigating the effect of RV infection on CRS. A mouse model of chronic allergic rhinosinusitis (CARS) was established by sensitizing to ovalbumin (OVA) through intraperitoneal injection followed by nasal challenges with OVA for 5 weeks. Both control and CARS mice were euthanized at 48 hours after infection with minor group RV serotype 1B (RV1B). Sinonasal complex samples were evaluated histologically; and interleukin (IL)-6, macrophage inflammatory protein (MIP)-2, IL-13, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ were measured in the nasal lavage fluid. The RV1B-infected areas in control and CARS mice were identified using immunofluorescence. In the infected control mice group, RV1B increased secretory hyperplasia in the sinonasal mucosa and the production of proinflammatory cytokines including INF-γ, MIP-2, and IL-13. Immunohistochemical analysis of nasal mucosa from RV1B-infected mice presented abundant RV1B staining, which was distributed between the epithelium and the lamina propria. In the CARS group, the RV1B-infected area per unit was significantly higher than that in control mice. However, RV1B infection neither increased the proinflammatory cytokine secretion nor worsened the histology significantly. We successfully established a mouse model of upper airway RV infection by nasal inoculation with RV1B. Although there was histologically-proven increased RV infection in the CARS model, the infection did not intensify sinonasal inflammation.

Correlates of Pediatric CPAP Adherence.

Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence. A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ(2) test. Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20-4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27-5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex. Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the pathophysiology of and to develop adherence-promoting and alternative interventions for pediatric OSA.

Qualitative effects of omalizumab on concomitant IgE-mediated disease in a severe asthmatic population: a real life observational study.

Omalizumab is a recombinant humanized monoclonal antibody (anti-IgE) licensed for use in GINA 5 asthma or for chronic idiopathic urticaria. Many patients with asthma have concomitant allergic diseases such as dermatitis and sinusitis. IgE is also implicated in allergic-bronchopulmonary disease (ABPA). In addition, extreme sensitivity to allergen can prevent the initiation of allergen immunotherapy. The aim of this study was to assess the efficacy of omalizumab on symptoms of concomitant non asthmatic IgE-mediated allergic disease in a population of severe GINA 5 in a real life observational setting. This study is a retrospective, observational study assessing patients reported allergic, non-asthmatic symptom response to omalizumab treatment. Fifty-six severe asthmatics treated with omalizumab were studied. Thirty-seven patients had concomitant rhino-sinusitis, 13 had dermatitis and 4 ABPA. Subjects were asked to grade the improvement in their symptom scores on an analogue scale from 0 (no response) to 10 (excellent response). Mean improvement from baseline was 5 and 1.8 in patients with allergic rhino-sinusitis and dermatitis, respectively. Mean improvement from baseline in respiratory symptoms in patients with ABPA was 4.0. The results from our study suggest that omalizumab may have a role in allergic disease outside of its current license.

New Model of Murine Allergic Rhinosinusitis Induced Cockroach Allergens

New Model of Murine Allergic Rhinosinusitis Induced Cockroach Allergens

Human nasal epithelial cells derived from multiple subjects exhibit differential responses to H3N2 influenza virus infection in vitro

Human nasal epithelial cells derived from multiple subjects exhibit differential responses to H3N2 influenza virus infection in vitro

Tracheobronchial Calcification with Sinus Destruction

A 34-year-old lady presented with history suggestive of bronchial asthma & allergic rhinosinusitis. Computerized tomogram (CT) of thorax showed nodular calcification of trachea with sparing of the posterior wall. CT paranasal sinus revealed sinusitis with bone destruction. Bronchoscopy and bronchial biopsy was consistent with the diagnosis of tracheobronchopathia osteochondroplastica (TPO). Diagnosis of atrophic rhino sinusitis was established based on the diagnostic criteria. Sinobronchial symptoms have been described in TPO, but destruction of sinus due to atrophic rhinosinusitis has not been reported.

The reasons of late diagnosis, difficulties and faults in supervision of patients with allergic rhinitis and rhinosinusitis. Analytical review and authors’ research

The article analyzes the practical experience of the authors and published data on the problem of the chronic adenoiditis. Variants of indications for surgical sanation of pharyngeal tonsils in case of chronic inflammation. The authors draw a conclusion that the use of antihistamine, immunomodulatory treatment and allergen-specific immunotherapy in adenoidites provide the best therapy results and make it possible to avoid surgery.

28-Day Repeated Oral Toxicity Study and Efficacy of a Siddha Polyherbal Formulation - Singinatha Choornam against Platelet Activating Factor-induced Rhinosinusitis in Wistar Albino Rat

Singinatha choornam is an oral polyherbal formulation used in the treatment of allergic rhinosinusitis cited in Siddha literature Agathiar Attavanai Vagadam. This study aimed to validate Singinatha choornam as an effective drug against platelet activating factor-induced rhinosinusitis in rat model. Safety study for Singinatha choornam was done by treating rats orally with 18, 90 and 180 mg/kg b.wt./p.o./day for 28 days following OECD 407 guidelines. No mortality, abnormal signs and symptoms, significant haematological, biochemical and histopathological variations were observed. A phospholipid inflammatory mediator, 50 µl were applied intranasally in rats of test and standard groups while control groups intranasally treated with 50 µl of distilled water as single application. Three groups of rat were allotted (control - distilled water 2 ml/dose, test drug - Singinatha choornam 90 mg/kg and standard - chloropheniramine maleate 1 mg/kg) and treated for 3 days. After end of the study, rats were sacrificed and examined for nasal sinuses and lamina propria histology. The count of neutrophils was reduced significantly in test group compared with control along absence of eosinophil. The study concludes Singinatha choornam has efficacy against rhinosinusitis in rat model but not so significant to standard treatment.

Modern approaches to therapy of allergic rhinosinusitis

The issue of allergic rhinosinusitis therapy is extremely urgent as of today. This is related, on the one hand, to the intense growth of the disease incidence, on the other hand, with aggravation of the allergic process course, addition of infectious complications, development of polysensitization. The approach to diagnostics of this disease must be consistent and complex. The accurate analysis of clinical manifestations and rational use of diagnostics tests are extremely important for the correct diagnosing. Allergic rhinitis is IgE-mediated primary chronic inflammatory disease of the mucous tunic of the nasal cavity. The basis of prescription of the rational therapy of this disease is clear understanding of pathogenic mechanisms of its development. Surgical therapy is indicated for these patients in the majority of cases, but it doesn’t have any pathogenic role.

Functional endoscopic sinus surgery in treating pediatric chronic rhinosinusitis: The Aseer Region experience

Objectives: This study aimed to investigate the clinical outcomes of functional endoscopic sinus surgery (FESS) in treating chronic rhinosinusitis (CRS) in Aseer Region children, and to look at the most likely etiologies that might be attributed to the need of surgical intervention in these children. Methods: Hospital charts for 47 children underwent FESS for CRS were retrospectively reviewed. We looked at the demographic information, clinical presentation, preoperative CT-scan reports and indications for the surgical procedure. Exclusion criteria include cases of FESS done by other surgeons, children below 4years and above 15 years, allergic fungal sinusitis, cystic fibrosis, mucocele and cases of antro-choanal polyps. Results: The majority of patients 38 (81%) presented with CRS were under the age of 8 years. The mean age was 6.5 years at presentation. There were 31 (66 %) males and 16 (34)% females. The persistent nasal discharge was the main symptom in 38 (81%) of the children. Eight (17%) children only presented with an associated nasal obstruction that was attributed directly to adenoid hypertrophy. Nineteen (40.4%) patients had obstructive anatomical variants and 28 (59.6%) patients were diagnosed having allergic rhinitis. Forty- one (87.2%) patient improved and required no further treatment and the remaining 6 (12.8%) patients required revision. Conclusions: Results of the present study are commensurate with findings from prior research in that they confirm that the FESS procedure is recommended to those who fail medical therapy and continue to have bothersome symptoms. Congenital anatomical obstruction (concha bullosa and Haller cells) followed by allergic rhinosinusitis havebeen found to be the most common etiological factors among the experimental group of children treated surgically.

Immunologic reactivity and metabolic activity of blood lymphocytes associated with pathogenic form of allergic rhinosinusitis

We had studied functional and metabolic activity of blood lymphocytes in allergic rhinosinusitis (ARS) - atopic ARS and polypous rhinosinusitis (PRS). ARS is characterized by the increased level of CD25+ and HLA-DR+-lymphocytes in peripheral blood, IgA concentration in blood serum and sIgA in nasal secretion. At the same time the deviation of immune response is directed towards Th2-lymphocytes and is accompanied by high content of IL-4 and IL-6 in blood serum and nasal secretion. The activity of metabolic enzymes in blood lymphocytes in ARS is caused by exasperation of plastic processes, intensification of lipoid catabolism and increase of the speed of both anaerobic and aerobic oxidation. There are the following specific features of PRS: high level of CD19+-cells, activation of Thl-lymphocytes and high level of those cytokines, which they produce (IFN-γ and IL-2 in blood serum and nasal secretion). At the same time intensification of aerobic enzymes and lipoid metabolism and decreasing of anaerobic processes and aminoacid metabolism in blood lymphocytes are in the progress.

Intranasal steroids in treatment of allergic rhinitis

Allergic rhinitis (AR) is one of the most common diseases affecting adults and children. AR is often a part of a systemic inflammatory process associated with other inflammatory conditions, including allergic conjunctivitis (Ac), rhinosinusitis and asthma. Undertreated AR impairs quality of life, exacerbates asthma and is a major factor in asthma development. There is a strong recommendation that clinicians recommend intranasal steroids (INS) for patients with a clinical diagnosis of AR whose symptoms affect their quality of life. All modern INS are minimally bioavailable and similar with regard to efficacy and safety at the recommended starting dose. however, differences in patient preference and safety of use during pregnancy may contribute to primary care physicians’ selection of an INS therapy for their patients.

Rhinology in the forefront of European political attention

On Oct. 14, 2015, a symposium on Precision Medicine in Allergy and Airways Diseases took place in the European Parliament in Brussels. The burden of disease in patients with rhinitis and rhinosinusitis was brought to the attention of European policy makers and different stakeholders involved in patient care, highlighting the high prevalence of allergic rhinitis and rhinosinusitis reaching epidemic proportions, the major socio-economic consequences and the impact uncontrolled disease despite evidence-based treatment. The Commissioner of Health and Food Safety of Europa, Vytenis Andriukaitis, as well as the presidents of large European Academies and Associations agreed upon the fact that a joint action plan is needed to arrest the epidemic of allergy and chronic airways diseases in Europe via joining forces between patient organizations, health care professionals and researchers.

Omalizumab in patients with eosinophilic granulomatosis with polyangiitis: a 36-month follow-up study

Objective: Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis characterized by asthma and blood eosinophilia, with the lung being the organ most frequently affected. Oral glucocorticoids and/or immunosuppressive drugs are the mainstay therapy of EGPA. Occasional reports suggest that EGPA patients can be treated with omalizumab in addition to conventional therapy to achieve asthma control. To investigate the long-term effects of omalizumab in patients with EGPA and asthma (2 females, 3 males, age 41–64 years), we carried out a 36-month follow-up observational study. At the time of enrollment, the patients were on maintenance therapy and had moderate to severe allergic asthma, eosinophilia and rhinosinusitis. Mononeuropathy/polyneuropathy and/or histological evidence of tissue eosinophilic infiltration were also present. Methods: Patients were treated with omalizumab (300–600 mg s.c. every 2–4 weeks) as add-on therapy to prednisone, inhaled steroids and bronchodilators. During omalizumab treatment, spirometry, the asthma control test (ACT) score and eosinophilia were evaluated, and prednisone dosage was recorded. Results: During the 36 months of omalizumab treatment asthma progressively improved as indicated by spirometry and the ACT score. Eosinophilia progressively decreased. The oral prednisone dose was reduced or withdrawn during treatment. No adverse events were recorded. Conclusions: In patients with EGPA and moderate to severe allergic asthma, omalizumab can be beneficial and safe. It enables corticosteroid tapering while decreasing eosinophilia and improving asthma symptoms over 36 months.

Induction of nasal polyps using house dust mite and Staphylococcal enterotoxin B in C57BL/6 mice

BackgroundThe murine polyp model was developed previously using ovalbumin and Staphylococcus aureus enterotoxin B (SEB). Here, we established a model mimicking key aspects of chronic eosinophilic rhinosinusitis with nasal polyps using the house dust mite (HDM), a clinically relevant aeroallergen, co-administered with SEB. We assessed the inflammatory response and formation of nasal polypoid lesions in an experimental murine model using intranasal delivery of HDM and ovalbumin. MethodsAfter induction of HDM-induced allergic rhinosinusitis in C57BL/6 mice, SEB (10ng) was instilled into the nasal cavity of mice for eight weeks. Phosphate-buffered saline-challenged mice served as control. Histopathological changes were evaluated using haematoxylin and eosin for overall inflammation, Sirius red for eosinophils, and periodic acid–Schiff stain for goblet cells. The distribution of mast cells in mouse nasal tissue was determined by immunohistochemistry. Serum total IgE was measured using enzyme-linked immunosorbent assay. ResultsCompared to mice treated with HDM only, the HDM+SEB-treated mice demonstrated nasal polypoid lesion formation and a significant increase in the number of secretory cells and eosinophilic infiltration. Moreover, mice challenged intranasally with HDM showed highly abundant mast cells in the nasal mucosa. In contrast, OVA+SEB-challenged mice showed a significantly lower degree of mast cell infiltration. ConclusionWe established an in vivo model of chronic allergic rhinosinusitis with nasal polypoid lesions using HDM aeroallergen. This study demonstrated that the HDM+SEB-induced murine polyp model could be utilised as a suitable model for nasal polyps, especially with both eosinophil and mast cell infiltration.

From Polyuria to Renal Mass: An Unexpected Link

From Polyuria to Renal Mass: An Unexpected Link