Nasal Eosinophilia Research Articles

Rapid and sustained effect of dupilumab on clinical and mechanistic outcomes in aspirin-exacerbated respiratory disease

Dupilumab, a mAb targeting IL-4Rα, improves upper and lower airway symptoms in patients with aspirin-exacerbated respiratory disease (AERD), but the mechanisms leading to clinical improvement are not fully elucidated. Our aim was to identify the mechanistic basis of clinical improvement in patients with AERD treated with dupilumab. A total of 22 patients with AERD were treated with dupilumab for 3 months for severe asthma and/or chronic rhinosinusitis with nasal polyps. Clinical outcomes were assessed at baseline and at 1 and 3 months after initiation of dupilumab. Nasal fluid, urine, blood, and inferior turbinate scrapings were collected at the 3 time points for determination of mediator levels, cellular assays, and RNA sequencing. Participants had rapid improvement in clinical measures, including sense of smell, sinonasal symptoms, and lung function after 1 month of treatment with dupilumab; the improvements were sustained after 3 months of dupilumab. Baseline severity of smell loss was correlated with lower nasal prostaglandin E2 levels. Dupilumab increased nasal prostaglandin E2 level and decreased levels of nasal albumin, nasal and urinary leukotriene E4, and serum and nasal IgE. Transcripts related to epithelial dysfunction and leukocyte activation and migration were downregulated in inferior turbinate tissue after treatment with dupilumab. There were no dupilumab-induced changes in nasal eosinophilia. Inhibition of IL-4Rα in AERD led to rapid improvement in respiratory symptoms and smell, with a concomitant improvement in epithelial barrier function, a decrease in inflammatory eicosanoid levels, and an increase in the anti-inflammatory eicosanoid prostaglandin E2 level. The therapeutic effects of dupilumab are likely due to decreased IL-4Rα signaling on respiratory tissue granulocytes, epithelial cells, and B cells.

The expression analysis of IL-6, IL-18, IL-21, IL-23, and TGF-β mRNA in the nasal mucosa of patients with Allergic rhinitis.

The profile of inflammatory and suppressing cytokines is important to contribute to the disruption of TH1/TH2 balance in Allergic rhinitis (AR). This study aimed to assess the expression levels of IL-6, IL-18, IL-21, IL-23, and TGF-β in nasal biopsies in AR patients and evaluate its correlation with the severity of AR. The study included 30 patients with mild persistent allergic rhinitis (MPAR), patients with moderate-to-severe (M/S) PAR, and 30 healthy individuals. The biopsies of nasal inferior turbinate mucosa were collected from each participant. The expression of IL-6, IL-18, IL-21, IL-23, and TGF-β was evaluated by the quantitative real-time polymerase chain reaction. The degree of eosinophil infiltration into the nasal mucosa, blood eosinophils, and total serum IgE level were also measured. The expression of IL-6, IL-18, and IL-23 in patients with AR significantly increased compared to the control group. Conversely, the gene expression of the TGF-β declined in the M/S PAR group rather than the AR- group. The data did not show a significant difference in the expression of the IL-21 gene between AR+ and AR- groups. We suggested that inflammatory cytokines including IL-6, IL-18, and IL-23 may be involved in the severity of AR and associated with markers of inflammation.

Development of allergic rhinitis in early life: A prospective cohort study in high-risk infants.

Allergic rhinitis (AR) is the most common allergic disease in children. The development process of AR in early childhood, however, is not well understood. We prospectively investigated the process in regard to not only the nasal symptoms and sensitization but also the nasal cytology, in relation to recurrent wheeze in a high-risk cohort. Infants under 2years of age with atopic dermatitis (AD) and/or food allergy (FA) symptoms were recruited and followed prospectively for 2years. The phenotype of perennial AR was classified based on the presence/absence of (1) persistent nasal symptoms, (2) nasal eosinophils, and (3) HDM sensitization, the most common allergen for perennial AR in Japan. AR-like phenotypes were defined as positive for at least two of those three categories. High-risk recurrent wheezer was diagnosed based on the Japanese guidelines and Global Initiative for Asthma. Cox proportional hazards regression analyses for high-risk recurrent wheeze and the AR-like phenotype, adjusting for known covariate risk factors for asthma. A total of 299 children were enrolled, and 237subjects (78%) completed the 2-year observation. The prevalence of eosinophilia in nasal secretions increased from 18.5% to 69.9%, while HDM-specific IgE≥0.35kUA /L increased from 30.6% to 74.8%. AR-like phenotypes increased from 18.4% to 65.0%. The AR-like phenotype at 2years was associated with development of high-risk recurrent wheezer (HR 2.062; 95% CI 1.005-4.796). The prevalence of an HDM-related AR-like phenotype was markedly increased during infancy in infants with AD/FA and was associated with high-risk recurrent wheezer.

The Effectiveness of Budesonide Nasal Irrigation in Patients with Allergic Rhinitis.

BackgroundAllergic rhinitis (AR) is a long-standing disease and has been shown to cause significant impairment in patients’ quality of life. Saline nasal irrigation is a proven adjunct in the treatment of AR. The addition of steroid to the saline solution can provide local steroid effect and increase the effectiveness of this technique. Our study aimed to determine the effectiveness of budesonide nasal irrigation as an adjunct to the treatment of AR, compared with saline nasal irrigation.MethodsThis was a randomised controlled study involving 99 patients diagnosed with AR, half of whom were treated with saline nasal irrigation and the other half with budesonide nasal irrigation. Parameters measured include the Sino-Nasal Outcome Test (SNOT-22) questionnaire, endoscopic nasal examination findings and blood eosinophil count.ResultsPatients treated with budesonide nasal irrigation had significant improvement in total SNOT-22 score (P < 0.001) and improvement in the endoscopic nasal examination findings, such as nasal mucosa oedema and secretions (P < 0.001). However, there was no significant improvement of blood eosinophil count in patients treated with either budesonide or saline nasal irrigation.ConclusionBudesonide nasal irrigation is effective as an adjunct in the treatment of AR.

Efficacy of Nasal Smear Eosinophil Count in Detecting Allergic Rhinitis in Children

Efficacy of Nasal Smear Eosinophil Count in Detecting Allergic Rhinitis in Children

Nasal cytology can predict clinical efficacy of subcutaneous immunotherapy in intermittent allergic rhinitis.

Allergen immunotherapy (AIT) is the only disease-modifying treatment option available for patients with IgE-mediated allergic rhinitis. The identification of specific biomarkers, which may predict response to AIT, is currently an active field of research in the aspect of recommended personalization of medicine. To assess the changes in rhinological parameters in intermittent allergic rhinitis (IAR) patients resulting from subcutaneous immunotherapy (SCIT). Forty-two patients (female: 19; 45%) with IAR qualified for subcutaneous immunotherapy were enrolled in this study. Fourteen (33.3%) patients were desensitized with grass pollen allergen extracts, 12 (28.6%) with tree pollen allergen extracts, and 16 (38.1%) with grass and tree pollen allergen extracts. The patients were evaluated before AIT during the pollen season and in the next pollen season after introduction of subcutaneous immunotherapy. On both occasions, determination of total nasal symptom score (TNSS), rhinomanometry and nasal cytology were performed. All examined parameters significantly improved after one course of allergen immunotherapy: the percentage of eosinophils in nasal mucosa, TNSS and nasal resistance decreased, whereas the nasal flow rate increased. The decrease in percentage of nasal eosinophils significantly correlated with improvement in TNSS (rs = 0.39, p < 0.05) and was the highest in the subgroup sensitive to grass pollen (44.5 (40-52)). The rhinological assessment confirmed high effectiveness of SCIT in intermittent allergic rhinitis. A high percentage of eosinophils in nasal cytology before subcutaneous immunotherapy can predict its clinical efficacy for intermittent allergic rhinitis, especially in grass pollen allergy.

TO EVALUATE EFFICACY AND SAFETY OF RUPATADINE, BILASTINE, AND LEVOCETRIZINE IN ALLERGIC RHINITIS AT TERITARY CARE HOSPITAL, TELANGANA

Objective: Allergic rhinitis (AR) is a heterogeneous disorder characterized by symptoms – sneezing, itching, nasal congestion, and rhinorrhea. The aim of the study is to evaluate the efficacy and safety of rupatadine, bilastine, and levocetirizine in AR. Methods: A prospective, open-label, comparative study was conducted at the Government ENT Hospital, Hyderabad, Telangana. Ninety patients diagnosed with AR were randomized, of whom Group 1 received oral tab. bilastine 20 mg once daily, Group 2 received oral tab. levocetirizine 5 mg once daily, and Group 3 received oral tab. rupatadine with a dose of 10 mg once daily for 2 weeks. The reduction in total nasal symptom score (TNSS) and absolute eosinophil counts (AECs) was compared with baseline and at 2 weeks. Safety was assessed according to adverse events reported during the study period. An analysis of variance was used as a test of significance for the three groups. Results: Overall, 90 cases were included in the study, with 48% of males and 52% of females. All three drugs significantly reduced the TNSS and AEC after treatment compared to before treatment (p&lt;0.05). The mean difference in TNSS and AEC showed no statistically significant difference among the three groups (TNSS: p&gt;0.908 and AEC: p&gt;0.967). In terms of safety, all three drugs showed nearly similar adverse events. Conclusion: In this study, after 2 weeks of follow-up, the three drugs (bilastine, levocetirizine, and rupatadine) showed significant improvement clinically, but the mean reduction in the score of symptoms and AEC was not statistically significant in the treatment of AR.

Mechanisms underlying the health effects of desert sand dust.

Desertification and climate change indicate a future expansion of the global area of dry land and an increase in the risk of drought. Humans may therefore be at an ever-increasing risk of frequent exposure to, and resultant adverse health effects of desert sand dust. This review appraises a total of 52 experimental studies that have sought to identify mechanisms and intermediate endpoints underlying epidemiological evidence of an impact of desert dust on cardiovascular and respiratory health. Toxicological studies, in main using doses that reflect or at least approach real world exposures during a dust event, have demonstrated that virgin sand dust particles and dust storm particles sampled at remote locations away from the source induce inflammatory lung injury and aggravate allergen-induced nasal and pulmonary eosinophilia. Effects are orchestrated by cytokines, chemokines and antigen-specific immunoglobulin potentially via toll-like receptor/myeloid differentiation factor signaling pathways. Findings suggest that in addition to involvement of adhered chemical and biological pollutants, mineralogical components may also be implicated in the pathogenesis of human respiratory disorders during a dust event. Whilst comparisons with urban particulate matter less than 2.5μm in diameter (PM2.5) suggest that allergic inflammatory responses are greater for microbial element-rich dust- PM2.5, aerosols generated during dust events appear to have a lower oxidative potential compared to combustion-generated PM2.5 sampled during non-dust periods. In vitro findings suggest that the significant amounts of suspended desert dust during storm periods may provide a platform to intermix with chemicals on its surfaces, thereby increasing the bioreactivity of PM2.5 during dust storm episodes, and that mineral dust surface reactions are an unrecognized source of toxic organic chemicals in the atmosphere, enhancing toxicity of aerosols in urban environments. In summary, the experimental research on desert dust on respiratory endpoints go some way in clarifying the mechanistic effects of atmospheric desert dust on the upper and lower human respiratory system. In doing so, they provide support for biological plausibility of epidemiological associations between this particulate air pollutant and events including exacerbation of asthma, hospitalization for respiratory infections and seasonal allergic rhinitis.

Systemic and local cytokine profile and risk factors for persistent allergic airway inflammation in patients sensitised to house dust mite allergens

ObjectiveTo evaluate cytokine profile, vitamin D status, symptom score and quality of life in patients with persistent allergic airway diseases sensitised to house dust mites (HDM) in comparison with healthy individuals.Material and methodsPatients sensitized to HDM with persistent AR and having symptoms for at least 2 years with or without AA were involved into the study. Measurements of vitamin D level in serum and IL-10, IL-13, IL-17, IL-22, IL-33 and IFN-gamma in serum and nasal lavage were performed by ELISA.ResultsEighty-one subjects were involved into the study. Serum IL-10 concentration was higher in patients with AR than in patients with AR and AA (6.71 ± 1.73 vs. 1.98 ± 0.24, p < 0.05). IFN-gamma level in nasal lavage was higher in patients with AR and AA than in patients with AR (p < 0.01) and healthy individuals (p < 0.05) (7.50 ± 0.37 vs. 6.80 ± 0.99 vs. 6.50 ± 0.22). Serum IL-22 negatively correlated with IL-22 in nasal lavage, whereas serum IFN-gamma positively correlated with IFN-gamma in nasal lavage. Positive correlation between serum IL-17 and total IgE and negative correlation between IL-17 in nasal lavage and eosinophils in nasal smear were found in patients with AR and AA. Serum IFN-gamma decreased the risk of AR for healthy individuals. Serum IL-10 and vitamin D decreased risk for development of AA for patients with AR. IL-22 in serum and IL-10 and IL-33 in nasal lavage increased this risk.ConclusionNovel cytokines such as IL-22, IL-17 and IL-33 and vitamin D may be involved in pathogenesis of persistent airway inflammation in patients sensitized to HDM.

Efficacy of intranasal fluticasone propionate and budesonide in management of allergic rhinitis\u2014a prospective comparative study

BackgroundAllergic rhinitis (AR) or Hay fever is a chronic inflammation of the nasal mucosa induced by IgE-mediated hypersensitivity due to exposure of various allergens. AR occurs as a response against these inhaled allergens that cause inflammation of nasal mucosal membranes. In this study, a reliable treatment for allergic rhinitis with maximum effectiveness and minimal side effects was assessed. This study compared the effectiveness of intranasal Fluticasone propionate (FUP) and intranasal Budesonide (BUD) in reducing the eosinophil count and in improving the nasal and ocular symptoms. This prospective study was conducted on 62 cases of allergic rhinitis and patients with mild-to-moderate allergic rhinitis were selected for the study. They were randomly divided into two groups; group I consists of 30 patients who received intranasal Fluticasone propionate aqueous spray, total daily dose of 200 μg (50 μg/spray) as 2 sprays in each nostril administered once daily, whereas the group II consists of 32 patients who received intranasal Budesonide aqueous spray, total daily dose of 400 μg/day (100 μg/spray) as 1 spray in each nostril administered twice daily.ResultsAnalysis on patient-based symptom scores revealed that both the groups showed statistically significant reduction in symptoms. Fluticasone propionate was found to be significantly more effective (P < 0.05) than Budesonide in reducing sneezing, nasal itching and majority of symptoms of individual symptom scores. Budesonide showed somewhat similar effect in reducing nasal blockage at 4 weeks of treatment.ConclusionClinically, both the drugs showed statistically significant improvement when compared to baseline, but Fluticasone propionate was superior at reducing nasal symptoms, ocular symptom and eosinophil count.

Correlation of absolute eosinophil count, nasal smear eosinophilia and serum IgE levels in allergic rhinitis

Allergic rhinitis (AR) is one of the most common disease in India. The association between eosinophils and allergic diseases has been known since many years. To correlate Nasal smear eosinophilia (NSE), blood absolute eosinophil count (AEC) and total serum IgE levels with severity of the clinical score in patients with allergic rhinitis. This is one-year prospective study in patients (n=60) presented with allergic rhinitis to our institute. After taking consent, all the study participants were subjected for blood AEC, IgE levels and nasal smears for eosinophils. Among the samples, 81.7% were males. The mean age of patients was 35.2 years. AEC &amp;#62; 440 cells/cu.mm was seen in 46.6%, NSE&amp;#62;10% in 81.6% and total serum IgE was elevated &amp;#62; 100 IU/ml in 95.0%. There was a good correlation of NSE and serum IgE with the severity of disease. There was no correlation of blood AEC with the severity of clinical score. Data was analysed using SPSS software.rn NSE and IgE both correlated well with severity of the disease. Nasal smear cytology is a simple procedure having good correlation with severity of clinical score should be used routinely. Testing for serum IgE levels will increase the accuracy with a better diagnostic utility.

Study of Eosinophil Count in Nasal and Peripheral Blood Smear Compare with Serum IgE Level in Children with Allergic Rhinitis

Introduction: Allergic rhinitis is one of the most common respiratory diseases. Patient with allergic rhinitis may have elevated level of serum IgE and eosinophil than normal person. Nasal smear eosinophil count is a simple test as well as noninvasive, can be repeated and inexpensive method for diagnosis of allergic rhinitis. Objective: To assess the eosinophil count in nasal smear as an alternative diagnostic test for children with allergic rhinitis. Methods: This cross-sectional study was conducted at the Department of Laboratory medicine and Paediatrics, BSMMU, Dhaka from September 2019 to August 2020 in 120 children (Age up to 18 years both sex). Diagnosed patients of allergic rhinitis according to ARIA-WHO guideline with history and clinical feature who fulfilled the inclusion criteria were selected as study population. After taking informed written consent blood and nasal secretion of allergic patient were drawn for serum IgE and eosinophil count. Nasal smears for eosinophil were stained using Giemsa stain and observed eosinophil under light microscope. Peripheral blood eosinophil count was estimated by hematology auto-analyzer (SYSMEX-XN 2000) and rechecked manually. The serum total IgE level was performed based on sandwich principle of ELISA. Results: The serum IgE level, nasal smear eosinophil count and blood eosinophil count were found increased with severity of allergic rhinitis, which was statistically significant (p&lt;0.001). Pearson’s correlation coefficient test revealed significant positive correlation between nasal smear eosinophil count with serum IgE (r= +.656, p&lt;0.001) and blood absolute eosinophil count (r= +.415, p&lt;0.001). Conclusion: Nasal smear eosinophil count was significantly raised alone with absolute eosinophil count and serum IgE level with the severity of allergic rhinitis in children.

Different concentrations of specialized pro-resolving mediators in eosinophilic and non-eosinophilic chronic rhinosinusitis with nasal polyps

Objective: To investigate the difference of concentrations of specialized pro-resolving mediators (SPMs) derived from fatty acids in eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) and non-eosinophilic chronic rhinosinusitis with nasal polyps (nECRSwNP). Methods: A total of 36 patients with bilateral chronic rhinosinusitis with nasal polyps (CRSwNP) who underwent endoscopic nasal surgeries in Peking Union Medical College Hospital from May 2019 to September 2020 were enrolled, including 27 males and 9 females, with the age from 13 to 67 years. There were 23 cases of ECRSwNP and 13 cases of nECRSwNP. At the same time, 12 control subjects were enrolled. The concentrations of multiple SPMs, including lipoxins (LXA4 and LXB4), resolvins (RvD1, RvD2, RvD3, RvD5 and RvE1), protectins (PDX) and maresins (Mar-1) in nasal polyps with different histological subtypes and normal nasal mucosa were analyzed using liquid chromatography-tandem mass spectrometry. The concentrations of SPMs between groups were compared using Mann-Whitney U test. Spearman's rank correlation coefficient was used to measure the correlation between the concentrations of SPMs in nasal polyps and tissue eosinophil counts. Results: The concentrations of RvD2, RvD3, RvD5, LXA4, LXB4, Mar-1 and PDX in ECRSwNP group were significantly higher than that in controls (Z value was -2.276, -2.313, -3.371, -2.094, -2.051, -3.104 and -2.294, respectively, all P<0.05). The concentrations of RvD2, RvD5, Mar-1 and PDX in ECRSwNP group were significantly higher than those in nECRSwNP group (Z value was -2.175, -2.289, -2.243 and -2.124, respectively, all P<0.05). There was no significant difference in all these SPMs between nECRSwNP and controls (all P>0.05). The concentrations of RvD2, RvD3, RvD5, LXB4, Mar-1 and PDX in nasal polyps correlated positively with tissue eosinophil counts (r value was 0.443, 0.436, 0.371, 0.502, 0.340 and 0.386, respectively, all P<0.05). Conclusions: A varienty of SPMs are elevated in ECRSwNP. Dysregulation of fatty acid metabolism might play an important role in the chronic inflammation of ECRSwNP.

Efficacy of sodium hyaluronate in relieving nasal symptoms of children with intermittent allergic rhinitis: a randomized controlled trial.

Nasal irrigation is recommended as add-on therapy in patients with intermittent allergic rhinitis (AR). We aimed to evaluate the clinical efficacy of adding hyaluronic acid (HA) or normal saline solution (NSS) to nasal corticosteroid (NC) therapy as add-on therapy in improving quality of life and reducing nasal symptom scores of children with intermittent AR compared to NC therapy. In this 28-day long, open-label, randomized controlled trial, one puff of NC was administered once a day through both nostrils of 76 children with SAR (6-12years old), whose Total Nasal Symptom Score (TNSS) was ≥ 4. Twenty-six patients received NC only (Group 1); 24 patients received NSS (Group 2), and 26 patients received HA (Group 3) twice a day by means of nasal douche device. Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and TNSS were measured as subjective parameters, and nasal eosinophil count (NEC) in nasal cytology, nasal airflow (NAF), and resistance were measured as objective parameters. No significant difference was found in post-treatment between groups in terms of TNSS, PRQLQ, and NEC values. Mean values of post-treatment left NAF of the groups were significantly different (p = 0.030), and the mean value of Group 3 was the highest (mean ± SD = 247.62 ± 155.8 ccm/sn). In comparing pre- and post-treatment intragroup mean total NAR (TNAR) values, a statistically significant decrease was recorded only in group three (p = 0.025). The addition of HA to NC as an adjunct therapy in children with intermittent AR has limited beneficial effects in our study and deserves further investigation. The clinical trial registration number ID:NCT04752956.

The Association Between Paranasal Mucous Retention Cysts and Allergic Sensitization

ABSTRACT Objective: Although there is no consensus regarding the etiology of paranasal mucous retention cysts (MRCs) in the literature, several studies suggest an allergic etiology. This study aimed to investigate a potential association between paranasal MRCs diagnosed with MRI scans and allergic sensitization in the pediatric population. Materials and Methods: A total of 4559 MRI scans were retrospectively evaluated for MRC in patients who presented to the pediatric neurology outpatient clinic with headache complaints. Fifty children with MRI findings conclusive for paranasal MRC and 50 children without such findings were included in the study. All study and control patients were invited for atopy/allergy evaluation. Total IgE measurements, blood eosinophil levels, nasal smear and skin prick tests were performed to evaluate the allergic status of the children. In addition, an allergic rhinitis symptom questionnaire was administered. Results: The mean age was 13.0±2.8 years (median 14 y, range 6-18 y) with a female-to-male ratio of 1.4:1 in the study group. The prevalence of MRC was found to be 1.1% (50 in 4559). The two groups did not differ with regard to the frequency of blood eosinophilia, nasal eosinophilia, serum IgE levels, and allergic rhinitis symptom severity (p&gt;0.05). Positive skin test for at least one of the allergens tested was more common in the MRC group than the controls (40% vs. 16%, p=0.007). Multivariate analysis identified that a positive skin prick test for at least one allergen was a significant independent predictor of MRC (OR, 4.6; 95% CI 1.2-17.0, p=0.023). Conclusion: Our study showed that paranasal MRCs were significantly more frequent in atopic children compared to controls. Additionally, MRCs were found to be strongly associated with allergic sensitization. Keywords: Cysts, allergic rhinitis, children, diagnostic tests, signs and symptoms

Comparison of Fluticasone Furoate and Cetirizine Versus Fluticasone Furoate and Montelukast in Allergic Rhinitis

Background: The complexity of treatment in allergic rhinitis remains to be a global challenge. The medical treatment option for moderate-severe persistent allergic rhinitis is the combination of intranasal corticosteroid (INCS) and oral antihistamine or leukotriene receptor antagonist (LTRA). The combination INCS with LTRA is selected based on the presence of asthma. Purpose: To determine the effect of fluticasone furoate plus cetirizine administration comparing fluticasone furoate plus montelukast on nasal eosinophils count and clinical improvement in patients with moderate-severe persistent allergic rhinitis. Method: This study was purely experimental research with the study design randomized clinical trial, double-blind, pre and post test control. Patient were divided into two group. Group-1 received intranasal fluticasone furoate 110 μg once daily and oral cetirizine 10mg and Group-2 received intranasal fluticasone furoate 110 μg once daily and Montelukast 10mg. The treatment efficacy is assessed from nasal eosinophil count and total five symptoms score (T5SS) based on Visual Analogue Scale (VAS) before and 4 weeks after treatment. Result: Both groups show a decrease in the nasal eosinophil count and T5SS score based on VAS before and after treatment (p&lt; 0.05). The group-2 shows a statistically significant improvement in nasal obstruction and rhinorrhea compare to the group-1 (p &lt;0.05). The decrease in nasal eosinophil count and T5SS is higher in the group-2 than the group-1, however, it is not statistically significant. Conclusion: The combination of fluticasone furoate and montelukast is more effective in reducing nasal obstruction and rhinorrhea than the combination of fluticasone furoate and cetirizine.

Алергічний цілорічний риніт у дітей: ефективність і безпечність застосування препарату «Ергоцетал»

Purpose — to evaluate the efficacy and safety of levocetirizine («Ergocetal») in children with perennial allergic rhinitis (PAR). Materials and methods. 30 children aged 6–16 years with PAR were examined. All children were prescribed levocetirizine («Ergocetal») 5 mg in the form of tablets once a day for a month for the treatment of PAR. The criteria for the effectiveness of the treatment were: regression of the main nasal and ocular symptoms of PAR (rhinorrhea, nasal congestion, nasal itching, sneezing, itching and redness of the eyes) according to the visual analogue scale (VAS); dynamics of nasal eosinophilia in a smearst from the nasal mucosa. Results. The studies have shown that prescribe of levocetirizine «Ergocetal» in monotherapy for school-age children with mild and intermittent PAR had a positive therapeutic effect on nasal and ocular symptoms, as well as on the intensity of eosinophilic inflammation in the nasal mucosa. Established good tolerance and the absence of side effects of «Ergotal» in the examined children. Conclusions. Therapeutic efficacy, absence of adverse reactions, high adherence to treatment make it possible to recommend levocetirizine («Ergocetal») as monotherapy for mild and intermittent PAR in school children. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: allergic rhinitis, treatment, levocetirizine.

An Instant, Safe, Antihistamine, Anti-Inflammatory and Decongestant Polymeric Nasal Barrier to Prevent and To Treat Allergic Rhinitis in Children

Introduction: Allergic rhinitis (AR) in children is a common chronic pathology with a strong impact on patient quality of life. The main physiopathology affects the nasal cavity as a multi-factorial disease involving nasal mucosa damage, nasal inflammation with high concentrations of histamine, pro-inflammatory cytokines such as histamine, TNF-α, IL-4, IL-5, IL-6, IL-10, IL-13, and IgE antibodies on the nasal mucosa. Systemic entry of these proteins through damaged nasal mucosa maintains continued inflammatory and allergen cascades. Therefore, an ideal treatment should be multitarget in order to stop allergen exposure, inflammation, and nasal mucosa barrier degradation, but such treatments are nearly impossible to conceive. We envisaged an osmotic and protective nasal barrier film, not only capable of protecting the nasal mucosa from allergen exposure but also of trapping and neutralizing selected cytokines and cleaning the nasal surface continuously without using any harmful substance for children. Materials and Methods: We associated highly osmotic glycerol solution with specific plant polymers to conceive an osmotic but stable film. As plant polymers (tannins) can bind with selective proteins, a range of glycerol binding non-cytotoxic polymers were screened using the sandwich ELISA method to select those having binding affinity for allergen induced nasal proinflammatory cytokines. After verifying cytotoxicity and irritant potential, a 15-day observational clinical study was performed with approval from the ethics committee on 30 children aged between 4-13, suffering from allergic rhinitis. The test product (TP) was supplied in 15-ml nasal sprays and applied 2-3 times per day for a period of 15 days. Saline solution served as control (CP). The scores of nasal and ocular symptoms, effect on quality of life, eosinophil count in nasal smears, and need for antihistamine treatment was evaluated at the start, at 30 minutes and on days 2, 3 and 15 of treatment. Results: A few specific polymers were able to bind with selected cytokines and histamine at adequate filmogen concentrations. The osmotic film was stable, non-irritant and was able to clean the nasal mucosa continuously for 4-6h after each application. Clinical observations of Total Nasal Symptom Score (TNSS) grouping the scores of nasal congestion, runny nose, sneezing, and itching, revealed a strong decrease right after the 1st treatment in both groups but the reduction was much stronger and faster with the TP. The mean TNSS score reduction was 44.74% in CP vs 83.53% in the TP group after 7 days of treatment (p&lt;0.001). Total Ocular Symptom Score (TOSS) was decreased by 21.13% and 51.41% in CP v/s 35.12 and 99.59% in TP group on days 2 and 7, respectively. Nasal smear eosinophil count was equally strongly reduced in the TP v/s CP group. No treatment-related side effects were recorded in any of the groups. Conclusion: Protecting the nasal mucosa against allergens, neutralizing inflammatory cytokines, and keeping the nasal surface clean with an osmotic polymeric film, constitute a major breakthrough for the treatment of allergic rhinitis in children. This simple but scientific and logical approach should avoid exposing children to chemicals and to their long-term side effects.

A study of various diagnostic tests to identify offending allergens in patients of allergic rhinitis in a tertiary care centre in northern India

Background and Objectives: Allergic rhinitis, a global health issue, if left untreated cause serious conditions like asthma, sinusitis or ear infections. Precise identification of allergens is worthwhile since it may lead to improvement in therapy. Therefore, this study was undertaken to determine the common inhalant allergens causing allergy in and around Saharanpur by skin prick test, serum IgE levels, nasal smear eosinphilia and AEC levels. Materials and Methods: 50 patients diagnosed clinically to have allergic rhinitis were included in the study. Absolute eosinophil count, nasal smear for eosinophils, and total IgE levels (wherever possible) were determined. Skin prick tests using 46 common inhalant allergens were done and results analysed. Results: Increased absolute eosinophil count, nasal smear positive for eosinophil and raised total IgE levels were found to be present in 56%, 22% and 97% of the patients respectively. Frequency of positive skin prick test response to various group of allergens were — Pollen (80%), Dust (70%), Mite (52%), Insects (50%), Fungi (48%) and Epithelial antigens (20%). Overall, pollen of Parthenium (in 70%) followed by House dust (in 64%) were found to be the most common offending allergens. Conclusion: It can be concluded that skin prick test along with serum IgE levels used to identify the causative allergens is useful in the patients of allergic rhinitis. Keywords: Allergic rhinitis, Skin prick test, Aeroallergens, Nasal smear eosinophils, IgE.

Pharmacological Benefits of Triphala: A Perspective for Allergic Rhinitis.

Allergic rhinitis (AR) is considered a major nasal condition impacting a large number of people around the world, and it is now becoming a global health problem. Because the underlying mechanisms of AR are complex, the development of single-drug treatment might not be enough to treat a wide spectrum of the disease. Although the standard guidelines classify and provide suitable diagnosis and treatment, the vast majority of people with AR are still without any means of controlling it. Moreover, the benefits of AR drugs are sometimes accompanied by undesirable side effects. Thus, it is becoming a significant challenge to find effective therapies with limited undesirable side effects for a majority of patients suffering from uncontrolled AR. Aller-7/NR-A2, a polyherbal formulation, has revealed promising results in patients by reducing nasal symptoms and eosinophil counts without serious adverse effects. Interestingly, three out of seven of the herbals in the Aller-7/NR-A2 formulation are also found in an Ayurvedic polyherbal formulation known as “Triphala,” which is a potential candidate for the treatment of AR. However, there are no current studies that have examined the effects of Triphala on the disease. This review aims to describe the complexity of AR pathophysiology, currently available treatments, and the effects of Triphala on AR in order to help develop it as a promising alternative treatment in the future.