Chronic Rhinitis Research Articles

Association of autoimmune and autoinflammatory disorders with chronic rhinosinusitis in children

BackgroundIncreasing evidence suggests that autoimmune disorders and their immunomodulating medications may increase the risk of rhinosinusitis. The goal of this study is to determine if autoimmune and autoinflammatory diseases are associated with increased risk of chronic rhinosinusitis (CRS) in children. MethodsA retrospective case-control study of pediatric patients (age 2–18 years) seen in the West Virginia University Hospitals System in the past 10 years was performed. Cases were children with autoimmune or autoinflammatory diseases. Controls were children without any autoimmune or autoinflammatory disorders. Query of our electronic medical record (Epic) was performed using ICD-10 codes. Univariate (unadjusted) and multivariate (adjusted) logistic regression were used to calculate the strength of association of autoimmune or autoinflammatory disorders with CRS and the other airway disorders while adjusting for age, sex, and race. Results420582 pediatric patients were queried with mean age of 10.8 years (SD of 4.8, range of 2–18 years), and 47.9% being female. 1956 (0.5%) had autoimmune disorders and 293 (0.07%) had autoinflammatory disorders. Both autoimmune and autoinflammatory disorders increase the odds of having CRS in the unadjusted [OR = 3.36, p < 0.001 and 5.69, p < 0.001 for the respectively] and the adjusted [OR = 2.90, p < 0.001 and OR = 5.07, p < 0.001 respectively after adjusting for age, sex, and race] models. ConclusionAutoimmune and autoinflammatory disorders increase the risk of CRS and chronic rhinitis in children.

The Fractional exhaled Nitric Oxide (FeNO)- test as add-on test in the diagnostic work-up of asthma: a study protocol.

Asthma is a common disease characterized by chronic inflammation of the lower airways, bronchial hyperactivity, and (reversible) airway obstruction. The Global Initiative of Asthma Guideline recommends a flowchart to diagnose asthma with first-step spirometry with reversibility and a bronchial challenge test (BPT) with histamine or methacholine as a second step [1]. The BPT is considered burdensome, time-consuming for patients and staff, can cause side effects, and is expensive. In addition, this test strongly encumbers lung function capacity. Elevated Nitric Oxide (NO) is associated with airway eosinophilic inflammation in asthma patients and can be measured in exhaled air with the Fractional exhaled (Fe) NO-test. This low-burden FeNO-test could be used as an 'add-on' test in asthma diagnostics [2, 3]. This multi-center prospective study (Trial number: NCT06230458) compares the 'standard asthma diagnostic work-up' (spirometry with reversibility and BPT) to the 'new asthma diagnostics work-up' (FeNO-test as an intermediate step between the spirometry with reversibility and the BPT), intending to determine the impact of the FeNO-based strategy, in terms of the number of avoided BPTs, cost-effectiveness and reduced burden to the patient and health care. The cost reduction of incorporating the FeNO-test in the new diagnostic algorithm will be established by the number of theoretically avoided BPT. The decrease in burden will be studied by calculating differences in the Visual Analogue Scale (VAS) -score and Asthma Quality of Life Questionnaire (AQLQ) -score after the BPT and FeNO-test with an independent T-test. The accuracy of the FeNO-test will be calculated by comparing the FeNO-test outcomes to the (gold standard) BPTs outcomes in terms of sensitivity and specificity. The intention is to include 171 patients. The local medical ethics committee approved the proposed study and is considered a low-burden and risk-low study. The local medical ethics committee registration number: R23.005. Strengths: This is the first study that investigates the value of the FeNO-test (cut off ≥ 50 ppb) as an add-on test, to determine the impact of the FeNO-based strategy, in terms of the number of avoided BPTs, cost-effectiveness, and reduced burden on the patient and health care. High FeNO levels may also be observed in other diseases such as eosinophilic chronic bronchitis and allergic rhinitis. The FeNO-test can be used to rule in a diagnosis of asthma with confidence, however, due to the poor sensitivity it is not suitable to rule out asthma.

Dependence of hematological parameters on the microbiota of the nasal mucosa in chronic rhinitis

Relevance. Chronic rhinitis is one of the most common otorhinolaryngological diseases. We assume that dysbiosis of the nasal mucosa depends on the phenotype of chronic rhinitis and affects hematological characteristics.&#x0D; Aim. Study of the hematological parameters dependence from the microbiota of the nasal mucosa in patients with various forms of chronic rhinitis.&#x0D; Material and methods. The examination groups included 45 patients with chronic allergic rhinitis (CAlR), 49 patients with chronic vasomotor rhinitis (CVR), 32 patients with chronic atrophic rhinitis (CAR), 39 patients with chronic infectious rhinitis (CIR) and 40 people from the control group. The subjects with chronic rhinitis, as well as the control group, underwent bacteriological examination of the nasal mucosa and assessment of hematological parameters. Statistical analysis was carried out using the Statistica 10 package.&#x0D; Results. The microbiome of the nasal mucosa is characterized by 100% infection with infectious agents in CIR, while fungal flora was detected in 1/3 of cases. The microbiological features of the nasal mucosa in CVR corresponded to the control, in CAR rhinitis - predominantly the growth of Klebsiella spp., in CIR - Staphylococcus spp., Streptococcus spp., Neisseriae spp., Escherichia spp. Hematological features manifested themselves depending on the form of chronic rhinitis. The greatest number of changes in blood parameters is found in CIR and CAR, less in CAlR, no changes were detected in CVR. The greatest dysbiosis of the nasal mucosa in CIR, the abundant growth of microorganisms of the genus Klebsiella spp in CAR corresponds to the largest number of changes in hematological parameters, and CVR is characterized by the absence of changes in hematological parameters, despite the fact that the microbiological characteristics of the nasal mucosa corresponded to the control.&#x0D; Conclusion. The microbiota of the nasal mucosa in healthy people and patients from the groups with CAlR, CVR and CAR is represented by a combination of coccal and rod-shaped flora, with the exception of CIR, in which representatives of the fungal flora are identified. Pathogenetically significant is the identification of representatives of Staphylococcus spp., Streptococcus spp., Neisseriae spp., Escherichia spp. in CIR, and Klebsiella spp. in CAR. Most hematological changes are detected in chronic atrophic and infectious rhinitis.

Patient Questions Surrounding Posterior Nasal Nerve Ablation for Chronic Rhinitis

AbstractObjectiveIn‐office ablation of the posterior nasal nerve (PNN) has emerged as an effective treatment option for chronic rhinitis patients. This study explored questions patients commonly search online regarding this therapy and the quality of content available.Study DesignA retrospective analysis of online search criteria and sources was performed with subsequent analysis of results.SettingSearch and data acquisition was in September of 2023.MethodsMost common search terms related to cryotherapy and radiofrequency neurolysis of the PNN were identified with associated People Also Ask (PAA) questions. Questions were categorized and organized into subtopics and sources evaluated using readability and quality metrics.ResultsA total of 255 unique PAA questions and 175 unique websites were identified. The most common subtopics were related to facts about chronic rhinitis (26.7%) and rhinitis treatment options (25.1%). Nearly a quarter (24.3%) of websites were from commercial sources. Quality metrics indicate difficult‐to‐read and low‐quality materials.ConclusionExisting online resources need improvement to provide patients material that is easier to read. Physicians counseling patients should be aware of these areas for adequate shared decision making.

Ameloblastic Carcinoma of the Maxilla With Uncommon Sinus Manifestations.

Ameloblastic carcinoma (AC) represents a distinct challenge in the realm of odontogenic malignancies due to its rarity and aggressive nature. We present a unique case of AC in a 70-year-old male, retired dry cleaner, with symptoms initially suggestive of chronic allergic rhinitis and recurrent acute sinusitis with asymmetric facial edema and paresthesia. Detailed evaluation revealed a prominent mass in the right maxillary sinus with extensive cortical destruction. Pathological assessment post-right maxillectomy identified a high-grade AC with malignant spindle cell transformation. The patient underwent subsequent interventions, including neck dissection and radiation therapy. Twelve months post-presentation, the patient was recovering appropriately without evidence of recurrence of malignancy. This case highlights the diagnostic challenges posed by AC as well as its unique presentations emphasizing the importance of a comprehensive approach and multidisciplinary management. It also raises considerations about potential chemical exposure implications in AC development.

A Review on Novel Therapeutic Modalities and Evidence-based Drug Treatments against Allergic Rhinitis.

Allergic rhinitis (AR) is an IgE-mediated atopic disease that occurs due to inhaled antigens in the immediate phase. Misdiagnosis, insufficient treatment, or no treatment at all are frequent problems associated with the widespread condition known as chronic allergic rhinitis. AR symptoms include runny, itchy, stuffy, and sneezing noses. Asthma and nasal polyps, for example, sometimes occur simultaneously in patients. In order for people living with AR to be as comfortable and productive as possible, treatment should center on reducing their symptoms. The online sources and literature, such as Pubmed, ScienceDirect, and Medline, were reviewed to gather information regarding therapeutic modalities of AR and evidence-based treatments for the disease as the objectives of the present study. An increasing number of people are suffering from AR, resulting in a heavy financial and medical burden on healthcare systems around the world. Undertreating AR frequently results in a decline in quality of life. Treatment compliance is a critical challenge in the administration of AR. Innovative therapies are needed for RA to provide patients with symptom alleviation that is less expensive, more effective, and longer duration of action. Evidence-based guidelines are helpful for managing AR illness. Treating AR according to evidence-based standards can help in disease management. AR treatment includes allergen avoidance, drug therapy, immunotherapy, patient education, and follow-up. However, AR treatment with intranasal corticosteroids is more popular. Hence, in this review article, treatment options for AR are discussed in depth. We also discussed the incidence, causes, and new treatments for this clinical condition.

A systematic review of randomised controlled trials on topical nasal steroids.

Intranasal corticosteroids (INCs) are the first line of therapy for chronic sinonasal conditions such as rhinitis and rhinosinusitis. Among these, one of the most frequently used is beclomethasone dipropionate (BDP). Over the years many studies have evaluated the efficacy of BDP as part of therapy for chronic rhinosinusitis (CRS) and allergic rhinitis (AR) along with nasal washes, which seems to be very well tolerated. To analyse the data in the literature regarding the various therapeutic regimens of BDP in different sinonasal disease and their efficacy and tolerability. Using different search engines, the posology, efficacy, and tolerability of BDP were reviewed and a total of 64 full-length articles were examined for eligibility. After applying inclusion and exclusion criteria, 4 articles were reviewed. BDP is among the group of INCs with significant improvement of nasal symptoms and has good efficacy and safety. BDP nasal spray is one of the most frequently prescribed INC for rhinitis and rhinosinusitis. Treatment with BDP resulted in significant and clinically meaningful improvements in nasal symptoms associated with AR and CRS. BDP is well tolerated, and the safety profile is similar to that of placebo in most patients. These results, in conjunction with the significant benefit reported in subjects with CRS and AR, provide convincing evidence of the overall effectiveness of BDP for the treatment of the full spectrum of sinonasal disease.

The Application of mHealth and Artificial Intelligence to Chronic Rhinitis

The Application of mHealth and Artificial Intelligence to Chronic Rhinitis

CHRONIC RHINITS WITH BRONCHITIS IN DOMESTIC CAT

Chronic rhinitis in cats is a syndrome associated with inflammation of the nasal cavity; it is often associated with secondary infection of the frontal sinuses, and usually lasts more than 1 month. This case study aims to determine the conclusion of several supporting examinations performed to diagnose chronic rhinitis in cats and its treatment. Examination was made on a 3-year-old female local cat with a body weight of 2.65 kg with a history of nasal discharge since approximately 2 years ago, sneezing, and occasionally followed by coughing with harsh-sounding breath. Physical examination showed a rough sound or stridor when the cat breathed, mucopurulent discharge in both nostrils, sneezing with high frequency and occasionally followed by coughing. Cytologic examination of nasal swab revealed rod-shaped bacteria, degenerate and non-degenerate infiltration of neutrophils, lymphocytes, monocytes and plasma cells. Mild interstitial pattern in the lung, and increased opacity or ring-like opacities ("donuts") at some bronchial ends were observed on radiographic examination. Bacterial growth and identification tests were positive for Proteus sp. bacteria. The cat was diagnosed with chronic rhinitis with bronchitis and treated with Cefixime antibiotic (12 mg/kg BW; q12 h; PO), anti-inflammatory corticosteroid Methylprednisolone (2 mg/kg BW; q24 h; PO) with tappering off dose, mucolytic decongestant Bromhexin HCL (1 mg/kg BW; q24 hours; PO), and immunomodulator Caviplex (2 ml; q24 hours; PO). Treatment for 14 days showed an improvement in the cat's condition where nasal discharge that was previously mucopurulent became serous and at certain times no discharge was found, the frequency of sneezing and coughing decreased, and the cat could eat and drink comfortably. The decision to select an antibacterial agent to treat rhinitis should be made based on the results of pharyngeal and nasal discharge swab cultures.

Modified technique improves efficacy for in-office posterior nasal nerve ablation.

Posterior nasal nerve (PNN) ablation is a minimally invasive treatment option for patients with chronic rhinitis. Recent evidence shows that parasympathetic innervation of the nasal cavity is more extensive and there are many fibers posterior to the lateral attachment of the middle turbinate. We describe a modified ablative technique that targets the extensive innervation of the posterior nasal nerves. Description of the technique and retrospective cohort analysis. In addition to the traditional radiofrequency and cryoablation targets, three additional treatment sites posterior to the middle turbinate were targeted using radiofrequency ablation, as well as one focused treatment posteroinferior to the middle turbinate attachment using cryotherapy ablation. The primary outcome collected was a 30% improvement in overall rhinitis symptoms. Forty-five patients received treatment and completed 3-month follow-up using the modified technique for radiofrequency and cryotherapy PNN ablation. Previously, our institution documented a 64.5% responder rate at 3 months. After introducing the modified technique, the response rate at 3 months significantly improved (64.5% vs. 91.1%, p = .004). This report suggests improved efficacy with implementation of the modified technique for in-office PNN ablation. Given the extensive nature of the post-ganglionic parasympathetic fibers of the nasal cavity which often emerge posterior to the middle turbinate attachment, a modified technique to target these branches should be considered. Prospective randomized studies comparing this modified technique to the traditional technique are needed. III.

REVISITING EVIDENCE OF PANCHGAVYA FOR HUMAN HEALTH AND ENVIRONMENT

Bhaishajya Ratanavali defines Panchgavya as the group of five obtained from cows. These are Godudgh (Cowmilk), Godadhi (Cow curd), Goghrita (Cow ghee), Gomutra (Cow urine) and Gomaya (Cow dung). Panchgavya benefits humans and the environment in many aspects such as agriculture, pharmaceutics, and treatment. Cow dung and urine are used as best fertilizers due to abundance of micronutrients and macronutrients, which increase soil quality. Cow urine, ghee and milk used as media in purification of drugs. Ksheer (Cow milk) and Ghrit are only two materialistic things recommend in Achara Rasayana (code of conduct). Many studies have been published to evaluate efficacy of Gomutra in Pandu (anemia), Kushtha (skin disorder), Arsha (hemorrhoids) and Udar roga (abdominal disorder). Gorasa (Cow milk) is best Rasayana (rejuvenation) and Jivaniya dravya (beneficial for life), Goghrita is referred as Chakshushya (beneficial for eyes), provides strength, complexion, good voice, and intelligence. Godadhi is indicated in Atisar (diarrhea), Pinasa (chronic rhinitis), Aruchi (anorexia), Mutrakruchha (dysuria) and Kshaya (emaciation). This review article highlights the diverse uses and probable modes of action in detail.

The Prevalence of the Nasal Vestibular Body in Patients With Nasal Obstruction.

Background and aim Nasal obstruction is one of the most common reasons for consultation addressed by otolaryngologists. There are anatomical, physiological, and pathological etiologies. Sometimes the treatment can become a challenge for the specialist, so a detailed evaluation of the etiologies must be carried out. The involvement of the nasal vestibular body (NVB) in obstructive symptoms has been described. Therefore, we must be familiar with its anatomy, presentation, and contribution to this symptomatology. This study aimed to highlight the importance of NVB in the role of nasal obstruction and know the impact that it adds to the symptoms of patients through a validated instrument on their quality of life. Material and methods A retrospective, descriptive, and analytical study was conducted on 113 patients with nasal obstruction who attended the outpatient clinic of the Otolaryngology and Head and Neck Surgery Service in a tertiary-level hospital in Monterrey, Mexico from January 2021 to January 2023. The Nasal Obstruction Symptom Evaluation (NOSE) scale was applied to assess the impact of this symptom on the quality of life of the subjects. The causes involved in the obstructive symptoms were identified by physical examination, including NVB. Two groups were made as follows: with the presence of the NVB and with the absence of the NVB, and the means of the NOSE scale were compared. Results A total of 113 patients were included, 59 male patients (52.20%) and 54 female patients (47.80%). The presence of NBV was found in 72 patients (63.70%). Other causes of nasal obstruction were found in 35 patients (31%), with chronic rhinitis being the most frequent in 27 subjects (23.90%). The mean NOSE scale score was higher in the group with the presence of the NVB than in the group with the absence of the NVB (p<0.05). The primary outcome of this study was to know the prevalence of NVB in the Hispanic population with nasal obstruction who attends the otolaryngology clinic. The secondary outcome was to know the relationship between the presence of NVB and the NOSE scores. Conclusion In this study, we observed that NVB is frequently present in patients with nasal obstruction in northeastern Mexico. There is an association between the presence of NVB and higher scores on the NOSE scale. New research will be needed to assess the effectiveness of NVB surgery in improving nasal obstruction and to determine the impact of NVB on nasal obstruction in isolation.

Nonallergic Rhinopathy: A Comprehensive Review of Classification, Diagnosis, and Treatment

Chronic nonallergic rhinitis syndromes encompass various conditions, of which vasomotor rhinitis is the most common form, representing approximately 80% of patients, also referred to as nonallergic rhinopathy (NAR), nasal hyperreactivity, neurogenic rhinitis, or idiopathic rhinitis. Expert panels have recommended replacing vasomotor rhinitis terminology because it is more descriptive of this condition that is characterized by symptoms triggered by chemical irritants and weather changes through chemosensors, mechanosensors, thermosensors, and/or osmosensors activated through different transient receptor potential calcium ion channels. Elucidating the specific role of transient receptor potential vanilloid 1, triggered by capsaicin, has been an important advancement in better understanding the pathophysiology of NAR because it has now been shown that downregulation of transient receptor potential vanilloid 1 receptors by several therapeutic compounds provides symptomatic relief for this condition. The classification of NAR is further complicated by its association with allergic rhinitis referred to as mixed rhinitis, which involves both immunoglobulin E-mediated and neurogenic mechanistic pathways. Comorbidities associated with NAR, including rhinosinusitis, headaches, asthma, chronic cough, and sleep disturbances, underscore the need for comprehensive management. Treatment options for NAR include environmental interventions, pharmacotherapy, and in refractory cases, surgical options, emphasizing the need for a tailored approach for each patient. Thus, it is extremely important to accurately diagnose NAR because inappropriate therapies lead to poor clinical outcomes and unnecessary health care and economic burdens for these patients. This review provides a comprehensive overview of NAR subtypes, focusing on classification, diagnosis, and treatment approaches for NAR.

Study of vitamin D levels in patients with allergic rhinitis

Allergic rhinitis (AR) is the most common type of chronic rhinitis, affecting 10-20% of the population. Severe allergic rhinitis has been associated with significant impairments in quality of life, sleep, and work performance. Vitamin D and its role in regulation of immune function was first proposed after the identification of vitamin D receptors in lymphocytes. There are recent researches linking vitamin D to various immune-related conditions, including allergy, although the pattern of this relationship is still yet to establish. Methods and materials: an observational descriptive study conducted in the Outpatient Department of ENT of Sri Siddhartha Medical College, Tumkur, Karnataka, over a period of 1 year comprising of around 40 patients from 18-65 years of age suffering from allergic rhinitis patients were scored using Total nasal symptoms scoring system (TNSS) based on nasal symptoms. Also, Vitamin D levels are measured and based on these levels patients are graded. Results: Among 40 patients, male predominance with 23(57.5%) cases with mean age of 38.4 +/- 6.8. Majority of patients were in 7-10 TNSS with 15 patients accounting for 37.5%. Patients with severe allergic symptoms had mean vitamin D level about 19.6 +/- 4.2 ng/dl, patients with moderate symptoms were seen with mean vitamin D level 28.6 +/- 3.6 ng/dl and with mild symptoms 34.4+/- 2.8 ng/dl and the p value was significant (&lt;0.04) in our study. Conclusion: Vitamin D could improve allergy symptoms directly or indirectly by potentiating the anti-inflammatory effects of the medications used to treat allergy.

Drug therapy possibilities for various forms of chronic rhinitis accompanied by dry nose syndrome

Introduction. Dry nose syndrome is a polyetiological condition that is common among patients of all age groups from infancy to profoundly old age. The low effectiveness of treatment is associated with the progression of atrophic mucous membrane degeneration, which also affects the cartilaginous and bony parts of the nasal cavity. Significant impairment of the protective, respiratory and olfactory function leads to decreased quality of life of patients, delayed adaptation, and arrested psychosomatic and physical development of children. Herbal medications refer to the agents that have minimal toxicity and side effects and effectively facilitate the restoration of functional integrity of the mucous membrane.Aim. To discuss the results of studies on the effectiveness of natural medicines in the treatment of patients with dry nose syndrome.Materials and methods. We conducted a literature search and studied publications (articles and relevant abstracts) containing information on various diseases that are accompanied by dry nose syndrome, as well as therapeutic options for this syndrome in Russian and foreign databases. The material was selected according to the following keywords: dry nose syndrome, atrophic rhinitis, mint essential oil, pine essential oil, eucalyptus essential oil. The study was conducted using the search engines Scopus, PubMed, CyberLeninka, Elibrary.ru, Google Scholar.Results and discussion. The study results suggested the potential and benefits of the topical use of a combination medicine containing essential oils of eucalyptus, mint, and pine as a treatment and prophylactic medication in patients with dry nose syndrome.Conclusion. Dyshesol, a herbal medicine that is an oil solution, meets the requirements for complex pathogenetic therapy in patients with dry nose syndrome of various etiologies, and can be recommended as a preventive and therapeutic medication for all age groups, and children from the age of two.

Updated epithelial barrier dysfunction in chronic rhinosinusitis: Targeting pathophysiology and treatment response of tight junctions.

Tight junction (TJ) proteins establish a physical barrier between epithelial cells, playing a crucial role in maintaining tissue homeostasis by safeguarding host tissues against pathogens, allergens, antigens, irritants, etc. Recently, an increasing number of studies have demonstrated that abnormal expression of TJs plays an essential role in the development and progression of inflammatory airway diseases, including chronic obstructive pulmonary disease, asthma, allergic rhinitis, and chronic rhinosinusitis (CRS) with or without nasal polyps. Among them, CRS with nasal polyps is a prevalent chronic inflammatory disease that affects the nasal cavity and paranasal sinuses, leading to a poor prognosis and significantly impacting patients' quality of life. Its pathogenesis primarily involves dysfunction of the nasal epithelial barrier, impaired mucociliary clearance, disordered immune response, and excessive tissue remodeling. Numerous studies have elucidated the pivotal role of TJs in both the pathogenesis and response to traditional therapies in CRS. We therefore to review and discuss potential factors contributing to impair and repair of TJs in the nasal epithelium based on their structure, function, and formation process.

Identifying causal relationships between gastroesophageal reflux and extraesophageal diseases: A Mendelian randomization study.

Traditional observational and in vivo studies have suggested an etiological link between gastroesophageal reflux disease (GERD) and the development of extraesophageal diseases (EEDs), such as noncardiac chest pain. However, evidence demonstrating potential causal relationships is lacking. This study evaluated the potential causal relationship between GERD and EEDs, including throat and chest pain, asthma, bronchitis, chronic rhinitis, nasopharyngitis and pharyngitis, gingivitis and periodontal disease, cough, using multiple Mendelian randomization (MR) methods, and sensitivity analysis was performed. The Mendelian randomization Pleiotropy RESidual Sum and Outlier and PhenoScanner tools were used to further check for heterogeneous results and remove outliers. MR with inverse-variance weighted (IVW) showed a significant causal relationship between GERD and EEDs after Bonferroni correction. IVW results indicated that GERD increased the risk of chronic rhinitis, nasopharyngitis and pharyngitis (odds ratio [OR] = 1.482, 95% confidence interval [CI] = 1.267-1.734, P < .001], gingivitis and periodontal disease (OR = 1.166, 95% CI = 1.046-1.190, P = .001), throat and chest pain (OR = 1.585, 95% CI = 1.455-1.726, P < .001), asthma (OR = 1.539, 95% CI = 1.379-1.717, P < .001), and bronchitis (OR = 1.249, 95% CI = 1.168-1.335, P < .001). Sensitivity analysis did not detect pleiotropy. Leave-one-out analysis shows that MR results were not affected by individual single nucleotide polymorphisms. The funnel plot considers the genetic instrumental variables to be almost symmetrically distributed. This MR supports a causal relationship among GERD and EEDs. Precise moderation based on causality and active promotion of collaboration among multidisciplinary physicians ensure high-quality diagnostic and treatment recommendations and maximize patient benefit.

A Novel Bionebulizer Approach to Study the Effects of Natural Mineral Water on a 3D In Vitro Nasal Model from Allergic Rhinitis Patients.

Sulfurous thermal waters (STWs) are used as a complementary treatment for allergic rhinitis. However, there is scant data on the effects of STW on nasal epithelial cells, and in vitro models are warranted. The main aim of this study was to evaluate the dose and time effects of exposure to 3D nasal inserts (MucilAirTM-HF allergic rhinitis model) with STW or isotonic sodium chloride solution (ISCS) aerosols. Transepithelial electrical resistance (TEER) and histology were assessed before and after nebulizations. Chemokine/cytokine levels in the basal supernatants were assessed by enzyme-linked immunosorbent assay. The results showed that more than four daily nebulizations of four or more minutes compromised the normal epithelial integrity. In contrast, 1 or 2 min of STW or ISCS nebulizations had no toxic effect up to 3 days. No statistically significant changes in release of inflammatory chemokines MCP-1/CCL2 > IL-8/CXCL8 > MIP-1α/CCL3, no meaningful release of "alarmins" (IL-1α, IL-33), nor of anti-inflammatory IL-10 cytokine were observed. We have characterized safe time and dose conditions for aerosol nebulizations using a novel in vitro 3D nasal epithelium model of allergic rhinitis patients. This may be a suitable in vitro setup to mimic in vivo treatments of chronic rhinitis with STW upon triggering an inflammatory stimulus in the future.

Smoking, Urban Housing and Work-Aggravated Asthma are Associated with Asthma Severity in a Cross-Sectional Observational Study.

Severe asthma affects 5 to 10% of asthmatics and accounts for a large part of asthma-related morbidity and costs. The determinants of asthma severity are poorly understood. We tested the hypothesis that asthma severity was associated with 1) atopy and allergy and 2) markers associated with environmental exposure. Data from the FASE-CPHG study, a cross-sectional, observational, multicenter investigation, were analyzed to identify markers associated with asthma severity. Asthma severity was gauged using the ASSESS score, encompassing symptom control, exacerbations, FEV1 and therapeutic load. Bivariate and multivariate analyses were used to identify patient characteristics associated with the ASSESS score. The analysis involved 948 patients, with 592 women, of which 447 patients (47%) had severe asthma. Among these, 491 patients (52%) had at least one positive aeroallergen skin prick test and 525 (55%) had at least one allergic disease among atopic dermatitis, chronic rhinitis and food allergy. The mean±SD ASSESS score was 11.2±3.4. Characteristics associated with a higher ASSESS score were female sex, secondary or lower education, unemployed occupational status, smoking, work-aggravated asthma and urban housing. There was no association between the ASSESS score and allergic diseases, aeroallergen-specific skin prick tests and IgEs, or blood eosinophil counts. While atopy and allergy were frequent among asthmatics, neither was associated with asthma severity. Modifiable environmental factors such as smoking, urban housing and work-aggravated asthma were independently associated with asthma severity.

Letter Regarding "Improvement in Nasal Symptoms of Chronic Rhinitis after Cryoablation of the Posterior Nasal Nerve":Towarda Unified Airway Approach.

Letter Regarding "Improvement in Nasal Symptoms of Chronic Rhinitis after Cryoablation of the Posterior Nasal Nerve":Towarda Unified Airway Approach.