Differential Diagnosis Of Rhinitis Research Articles

Возможности цитологических исследований в дифференциальной диагностике ринитов

Введение. Диагноз «ринит» обычно ставится с учетом наличия двух или более симптомов со стороны носа: заложенность носа, выделения, чихание, зуд в носу, боль в лице или чувство давления, головная боль, заложенность ушей, снижение/потеря обоняния. Однако клинические данные не отображают весь спектр различных форм ринита, поэтому для дифференциальной диагностики необходимы дополнительные методы обследования. Цель. Определить фенотип ринита, выявив преобладающий тип клеток воспаления с помощью назоцитограммы. Материалы и методы. Под наблюдением находилось 100 человек. У 80 пациентов дифференциальная диагностика формы ринита вызывала трудности, а 20 человек (добровольцев) составили контрольную группу, их показатели были приняты за норму. Назоцитограммы выполняли с помощью мазков со слизистой оболочки носа. Материал наносился на предметное стекло, затем окрашивался: по Романовскому – Гимзе, по Май – Грюнвальду и толуидиновым синим. Далее производили подсчет клеток в мазке. Результаты. После анализа данных цитологии носового секрета пациентов с хроническим ринитом нами были установлены нозологические формы заболевания. Так, чаще других обнаруживались хронический инфекционный ринит – 14 (14%) пациентов и атрофический ринит – 14 (14%). Такие пациенты требовали дополнительных методов диагностики для установления причинного патогена и, следовательно, коррекции дальнейшего лечения. Локальный аллергический ринит (ЛАР) определили у 4 (4%). У 9 (9%) человек выявился NARES. Десять человек (10%) соответствовали NARESMA. Один человек (1%) страдал NARMA. Данные пациенты требуют тщательного дальнейшего контроля, так как прогноз по этим фенотипам ринита в большинстве случаев неблагоприятный. Четыре пациента (4%) страдали вазомоторным ринитом, а 17 человек (17%) не имели значимых изменений в анализе, что соответствовало идиопатическому риниту. Заключение. Успех в лечении хронических ринитов зависит от точности диагностики фенотипов и выбора адекватного комплекса лечения. Примененный нами цитологический метод исследования назального секрета дал возможность выявить различные формы неаллергического ринита при проведении дифференциальной диагностики. Метод высокоинформативный, прост в технической реализации. Его целесообразно широко применять в диагностическом комплексе для верификации фенотипов хронических ринитов. Introduction. The diagnosis of rhinitis is usually based on the presence of two or more nasal symptoms: nasal congestion, discharge, sneezing, nasal itching, facial pain or pressure, headache, ear congestion, decreased/loss of smell. However, clinical data do not reflect the full range of different forms of rhinitis, so additional examination methods are needed for differential diagnosis. Purpose. To determine the "phenotype" of rhinitis by identifying the predominant type of inflammatory cells using a nasocytogram. Materials and methods. 100 people were under observation. In 80 patients, the differential diagnosis of the form of rhinitis caused difficulties, and 20 people (volunteers) made up the control group, whose indicators were taken as normal. Nasocytograms were performed using swabs from the nasal mucosa. The material was applied to a glass slide, then stained: according to Romanovsky – Giemsa, according to May – Grunwald and toluidine blue. Next, the cells in the smear were counted. Results. After analyzing the data of cytology of the nasal secretion of patients with chronic rhinitis, we established the nosological forms of the disease. Thus, more often than others, chronic infectious rhinitis was found – 14 (14%) patients and atrophic rhinitis – 14 (14%). Such patients required additional diagnostic methods to identify the causative pathogen, and, consequently, the correction of further treatment. Local allergic rhinitis (LAR) was identified in 4 (4%). 9 (9%) people had NARES. 10 people (10%) matched (NARESMA). 1 (1%) person suffered from NARMA. These patients require careful follow-up, as the prognosis for these rhinitis phenotypes is poor in most cases. 4 patients (4%) suffered from vasomotor rhinitis, and 17 people (17%) had no significant changes in the analysis, which corresponded to idiopathic rhinitis. Conclusion. Success in the treatment of chronic rhinitis depends on the accuracy of diagnosing phenotypes and the choice of an adequate treatment complex. The cytological method used by us for the study of nasal secretion made it possible to identify various forms of non-allergic rhinitis during differential diagnosis. The method is highly informative, simple in technical implementation. It is appropriate to widely use it in the diagnostic complex for verification of chronic rhinitis phenotypes.

Nasal allergen challenge - an important tool in diagnosis of rhinologic disease

The nasal allergen challenge (NAC) is used in the diagnosis of rhinitis. The primary use of NAC is to confirm allergy to a specific inhaled allergen. NAC reproduces the allergic reaction of the nasal mucosa under standardized and controlled conditions that occurs after direct intranasal administration of allergens. As the only used method for assessing the degree of allergy, it mimics the body’s natural response to the sensitizing factor in the early and late stages of an allergic reaction. NAC is used in the diagnosis of chronic, occupational and local rhinitis, as well as in the differential diagnosis of rhinitis and ophthalmic symptoms. Under conditions similar to natural exposure, it determines the relationship between the allergen and symptoms of allergic rhinitis, especially in the case of difficulties in interpreting the results of skin tests and the serum concentration of specific IgE. It is a truly valuable tool in determining the indications for immunotherapy and the selection of allergens for desensitization therapy. It also serves as a method of monitoring the effectiveness of immunotherapy and pharmacotherapy. For scientific purposes, NAC is used to study the mechanisms of an allergic reaction and the influence of various factors on its course. It is considered safe, but requires appropriate instruments and qualified personnel.

Allergic rhinitis during a coronavirus pandemic: difficulties of diagnosis and features of therapy

Rhinitis can be of various etiologies. More often it is an infectious process (bacterial, viral) or clinical manifestations of an immediate allergic reaction. Other factors that provoke the development of rhinitis, for example, irritating substances, a number of drugs, hormonal imbalance, neurovegetative dysfunction, viruses are known. Doctors of various specialties are familiar with allergic rhinitis (AR) in their practice. In a number of cases there can be some difficulties in the differential diagnosis of rhinitis, the correct diagnosis and the appointment of adequate therapy. The COVID-19 epidemic (“coronavirus disease 2019”) has already been imprinted in the global history as an emergency of international importance. Scientific medical communities continue to study the characteristics of this epidemic, which is regarded by WHO as a pandemic. In a short period (from January 2020), there has been accumulated enough information about the etiology, features of the clinical manifestations of this disease, diagnostic methods have been developed, and clinical approaches and treatment regimens continue to be developed. The pandemic coincided with successive pollen seasons of trees, grasses and weeds. At the beginning of the pollen season, doctors were concerned about the possible difficulty in differential diagnosis of allergic rhinitis, manifestations of coronavirus and other viral infections. In the process of monitoring patients, more and more data has been accumulated, indicating the features of the clinical characteristics of COVID-19, influenza, acute respiratory infections, seasonal allergic rhinitis (rhinoconjunctivitis). Undoubtedly, information is still being accumulating and enriching day by day. AR is not only the most common form of rhinitis, but one of the most common diseases in children and adults. It is known about the pronounced negative effect of AR symptoms on the patient’s quality of life: normal daily activity, cognitive functions, mood, sleep. The severity of AR symptoms varies from minimal clinical manifestations to severe. Therapy should be directed towards the general control of AR symptoms. Over the past decades, the concept of phenotyping (definition of a disease by its clinical manifestations) and endotyping (based on the pathobiological mechanisms of the disease) has been developed. The belonging of AR in a particular patient to a certain phenotype plays a key role in choosing the most effective therapy and requires a personalized approach to treatment. The article provides frequently asked questions regarding AR treatment during the COVID-19 pandemic. The role of intranasal corticosteroids (InHCS), which are the most effective drugs in AR therapy, is discussed, due to their pronounced anti-inflammatory effect and influence on all stages of the pathogenesis of the disease. Mometasone furoate nasal spray has the widest indications among all InHCS drugs registered in our country.

The role of secretory immunoglobulin E in the differential diagnosis of rhinitis during pregnancy

To evaluate the role of secretory immunoglobulin E in the differential diagnosis of rhinitis in pregnant women. The study involved 97 pregnant women with rhinitis symptoms and 23 healthy pregnant women without rhinitis symptoms. The first group of the study included 37 pregnant women with previously confirmed (anamnestically and immunologically) allergic rhinitis (AR), the 2nd group of the study included 30 pregnant women with suspected beginning of the AR, the 3rd group of the study was 30 women with pregnant women's rhinitis, diagnosed on the base of follow-up study. The study included: anamnesis taking, routine examination of ENT organs, general clinical examination, study of the level of total IgE in blood, nasal secretion cytology study, secretory IgE level in nasal secretion analysis, follow-up telephone gathered catamnestic data analysis. When analyzing laboratory data, an increase in the average number of eosinophils in the blood was not detected in any group. When examining secretory immunoglobulin E of the nasal secretion in the group of patients with previously confirmed AR, this indicator averaged 2.9±0.7 kE/L, in the group with AR beginning - 5.5±2.6 kE/L, which exceeded the value in the control group (1.2±0.6 kE/l, p<0.05). In the group of patients with pregnant women's rhinitis, the indices of nasal IgE did not differ significantly from the control group (1.9±0.3 and 1.2±0.6 kE/L, respectively, p<0.05). The level of secretory nasal immunoglobulin E can be used in the differential diagnosis of rhinitis in pregnancy.

Pharmacotherapy of asthma: What do the 2007 NAEPP guidelines say?

The purpose of this article is to review the recommendations for pharmacotherapy in the new National Asthma Education and Prevention Program (NAEPP) guidelines. There are four main changes regarding pharmacotherapy in the updated guidelines. First, the recommendations for three age groups (0-4 years, 5-11 years, and > or =12 years) are presented separately. Second, the steps of therapy have been expanded from 4 steps to 6 steps to simplify the action within each step. Third, medium dose inhaled corticosteroids (ICS) or low-dose ICS plus add-on therapy are recommended for patients 5 years of age and older who are not controlled on low dose ICS. Finally, consideration of omalizumab is recommended for allergic patients 12 years of age and older who are not controlled on medium dose ICS plus long-acting beta agonists. For all age groups, the first step of therapy is inhaled short-acting beta agonists as needed and the second step is low dose ICS. Oral corticosteroids are part of step 6 therapy for all age groups. In patients not already on long-term control medications, the step of initiation of therapy is based on the assessment of severity. In patients on long-term control medications, therapy is adjusted based on the level of asthma control. If the patient is not well controlled, therapy is usually advanced one step. If the patient is very poorly controlled, consider stepping up two steps, a course of oral corticosteroids, or both. It is hoped that the updated NAEPP guidelines will lead to improved quality of life for patients with asthma.

Cough in specific populations (paediatric patients, elderly patients and patients with underlying disease)

Cough in specific populations (paediatric patients, elderly patients and patients with underlying disease)

Sneezing, runny, blocked or itchy nose: is it hay fever, a cold or something else?

Nasal symptoms such as a runny, itchy or blocked nose and sneezing indicate rhinitis but may have a variety of causes. This article describes the differential diagnosis of rhinitis and includes an explanation of the rarer conditions which need to be excluded when assessing patients for treatment. The treatment of infectious, allergic, occupational, hormonal and drug-induced rhinitis is discussed.

Prevalence and differential diagnosis of chronic rhinitis

The prevalence and differential diagnosis of rhinitis changes as we progress from birth to senescence. The heavy burden of allergic rhinitis is often overlooked in infants and disregarded in childhood and adolescence. In women, especially during pregnancy, hormonal changes can significantly affect nasal mucosal hyperreactivity and worsen ongoing syndromes. Various types of inflammatory and noninflammatory nonallergic rhinitides become more prevalent in the fifth decade and beyond. The burgeoning elderly population with irritant, atrophic, and medication-related rhinitis will constitute a greater proportion of our practices as the general population ages.

MECHANISMS OF RHINITIS

The differential diagnosis of rhinitis is broad. New concepts of lymphocyte subsets and cytokine production permit speculation about new disease classifications. For allergic rhinitis, mast cell degranulation is the major defining feature. Histamine remains preeminent for inducing the symptoms of allergic rhinitis, including itching, sneezing, dripping, and congestion. Histamine, however, is joined by a growing list of immediate and late-phase mediators that plague the muscosal surface. The mechanisms of symptom production in rhinitis are reviewed, focusing on the effects on mucosal resident cells, such as epithelium, endothelium, and glands, the role of nociceptive and parasympathetic nerves, and the recruitment and activation of leukocytes in the mucosa. The benefits and mechanisms of action of antihistamines anticholinergic agents, and glucocorticoids are discussed.

Measurement of blood flow to human nasal mucosa in normal and pathological conditions by the use of the 133Xe clearance technique.

The blood flow to nasal mucosa in normal subjects and in allergic rhinitis, vasomotor rhinitis and laryngectomized patients was measured using the 133Xe clearance technique. The results were statistically compared and correlated with capillary diameter. Compared to the normal group, the blood flow to nasal mucosa increased in allergic and vasomotor rhinitis patients and decreased in laryngectomized patients. There was a statistically significant difference between allergic and vasomotor groups (p less than 0.01), so the present method could be used in the differential diagnosis of rhinitis.

Mandibular Malalignment in the Pig

Jaw deviation and associated changes in the mandibular joint is described. The possible significance of the abnormalities in relation to snout measurements and the differential diagnosis of rhinitis is discussed. Clinical observations identified the condition in all 55 herds examined, the incidence increasing with age. In six herds examined in detail 43% of adult animals showed a degree of deviation. The condition is of little importance.