Nonallergic Rhinitis Research Articles

Characteristics of the patients with asthmarhinitis multimorbidity.

Asthma and allergic rhinitis frequently coexist and have been regarded as a single airway disease. Clinical features of patients with asthmarhinitis multimorbidity may change depending on the allergic sensitization pattern. The aim of our study is to determine the frequency, type, and characteristics of the patients with asthma-rhinitis multimorbidity. Patients who were followed up with a diagnosis of asthma between 2015 and 2020 in our clinic were included in our crosssectional study. Sociodemographic and clinical characteristics of the patients, rhinitis symptoms, and atopy status according to the results of the skin prick test, and sp IgE were recorded from the patient files. Asthma-rhinitis multimorbidity was seen in 138 (113 F/25 M) out of 405 asthmatics and the mean age was 45.51 ± 13.56 years. They were younger and the age of onset of asthma was earlier than asthma patients without rhinitis. The rate of concomitant allergic rhinitis (AR) was 25.9%, and the rate of non-allergic rhinitis (NAR) was 8.1% in the entire group. There was no difference between patients with AR and NAR in terms of comorbidities such as NSAID sensitivity, nasal polyps, chronic rhinosinusitis, and bronchiectasis but, gastroesophageal reflux disease was more common in those with NAR than in those with AR (39.4%, 18.1%, respectively, p= 0.01). Of 105 asthmatic patients accompanied by allergic rhinitis, 41 (39.09%) were monosensitized, and 64 (60.95%) were polysensitized. House dust mites were found to be the most common responsible allergen in monosensitized patients. Sensitization to two allergens was the most common pattern among polysensitized patients, and mites and mold association was the most frequent. Patients with monosensitized allergic rhinitis had more severe asthma and a higher rate of NSAID sensitivity than polysensitized patients (p= 0.03, p= 0.04, respectively). There was no difference in the control level, frequency of eosinophilia, and other comorbidities. Our patients with asthma-rhinitis multimorbidity were mostly polysensitized. The most responsible allergen for the sensitization was house dust mites, regardless of whether the patient was monosensitized or polysensitized.

Control of rhinitis: does the facial mask influence?

<p class="abstract"><strong>Background:</strong> The aim of the study was to understand the impact of face masks usage during the COVID-19 pandemic on allergic rhinitis to pollens symptoms. </p><p class="abstract"><strong>Methods:</strong> A total of 200 patients was included in this study, with 100 patients having a previous diagnosis of allergic rhinitis to pollens and 100 patients having a diagnosis of non-allergic rhinitis. All patients answered the Rhinitis control assessment test (RCAT) and were asked about symptom control after introduction of the mandatory use of face masks in public. Patients with a RCAT score of 22 or higher were considered to have symptomatic control. </p><p class="abstract"><strong>Results:</strong> 78% (n=78) of patients with allergic rhinitis to pollens reported improvement of symptoms after starting to use a face mask, with a mean score of 24.78 points (SD±3.13) on the RCAT. Among non-allergic rhinitis patients, 10% (n=10) reported improvement of symptoms, with 50% reporting worsening of symptoms and with a mean RCAT score of 21.54 (SD±3.23). A statistically significant difference (p<0.01) was found between the RCAT scores, with the allergic rhinitis group showing higher scores and, thus, better symptom control.</p><p class="abstract"><strong>Conclusions:</strong> The face mask appears to act as a barrier for patients with allergic rhinitis, helping improve symptomatic control, making this an option for an adjuvant treatment for allergic rhinitis to pollens.</p><p> </p>

Smoking and Sinonasal Disease: A Narrative Review

Tobacco smoke includes over 4,000 potentially harmful components. This study aimed to collect relevant content to evaluate the association between smoking and sinonasal diseases. PubMed, Scopus, Web of Sciences, and Google Scholar databases were searched for related articles from inception until 2021. Of the overall 560 retrieved articles, 67 cases remained for review after the exclusion of duplicates and unrelated papers. Tobacco smoke, whether first- or second-hand, is harmful to the nose and sinuses. Smoking is linked to various sinonasal disorders, including chronic rhinosinusitis (CRS), olfactory impairment, nasal polyps, allergic and non-allergic rhinitis, and certain cancers. The formation of bacterial biofilms, dysfunctional mucociliary clearance, oxidative stress, inflammation, apoptosis and cytotoxicity, and structural changes appear to be some of the potential mechanisms through which tobacco smoke affects the sinuses and the nose. Clinicians should consider the negative consequences of smoking on sinonasal disorders when treating patients with these conditions. Cessation of smoking may benefit these patients’ health.

Nonallergic Rhinitis, Allergic Rhinitis, and Immunotherapy: Advances in the Last Decade

Chronic rhinitis encompassing both allergic and nonallergic rhinitis affects a significant portion of the population worldwide, having a great impact on patient quality of life, and associated comorbid conditions, with an important societal economic burden. Allergists are often the first to evaluate and treat allergic and nonallergic rhinitis, addressing the individual triggers of the disease as well as the patient-specific responses to these triggers. This review focuses on the advances that have been made in the diagnosis, management, and treatment of nonallergic and allergic rhinitis over the past 10 years, including specific allergen immunotherapy, care pathways, and digital health.

DIFFERENTIATION BETWEEN ALLERGIC AND NON-ALLERGIC RHINITIS IN CHILDREN WITH CHRONIC RHINITIS, ALLERGY CLINIC, PHRAMONGKUTKLAO HOSPITAL

Background: Chronic rhinitis in children is a common problem. Investigation to diagnose allergic rhinitis (AR) using a skin prick test for aeroallergens requires a specialist doctor, which is not simply performed in primary health care facilities. Therefore, diagnosing patients with AR and non-allergic rhinitis (NAR) is based on clinical symptoms essential for treatment planning. This study compared clinical symptoms between AR and NAR, comorbidities, disease severity, and common aeroallergen sensitization.
 Methods: A retrospective descriptive study was conducted among participants aged between 2-18 years with chronic rhinitis who were treated at the Department of Allergy and Immunology, Division of Pediatrics, Phramongkutklao Hospital, between 2014 and 2018. The medical records were reviewed on clinical symptoms, allergic test results, environmental data, and the severity according to Allergic Rhinitis and its Impact on Asthma (ARIA) classification. If the patient tested positive for aeroallergen, the allergist diagnosed AR. NAR is characterized by the same symptoms but with a negative skin prick test.
 Results: Three hundred and seven participants were included. Among these patients, 226 (73.6 %) were categorized as AR, and 81 (26.4%) were NAR. The AR group had a higher percentage of males than the NAR group. Nasal pruritus and ocular symptoms were more commonly found in AR than in NAR. Regarding comorbidities, both groups had similar snoring, sinusitis, asthma, and atopic dermatitis. The most common aeroallergens among AR patients were Dermatophagoides pteronyssinus (82.7%), Dermatophagoides farinae (81.4%), followed by American cockroaches (38.1%), and German cockroaches (37.6%). Cat owners were associated with cat sensitization in AR patients (OR =2.77; 95% CI = 1.27-5.88).
 Conclusions: In this study, the proportion of AR was higher than NAR. Nasal pruritus, ocular symptoms, or both strongly supported AR. The most common aeroallergen sensitization was house dust mites, followed by cockroaches. Initial treatment with antihistamine and other drugs can improve the severity of the disease.

Comparison between the International Classification of Primary Care and the International Classification of Diseases Classifications in Primary Care in Korea.

BackgroundThe International Classification of Primary Care-2 (ICPC-2) is a classification method designed for primary care. Although previous studies have found that ICPC-2 is a useful tool for demonstrating the relationship between patients’ expectations and health providers’ diagnoses, its utility of ICPC-2 has yet to be fully studied in Korea. This study aimed to evaluate the practicality of ICPC-2 in Korean primary care.MethodsThe study was conducted at primary care clinics in Seoul and Gyeonggi areas from October to November 2015. Third-year family medicine residents examined and analyzed the medical records of patients who visited primary care physicians using ICPC-2, and the results were compared with those obtained using the International Classification of Diseases-10 (ICD-10) (Korean version: Korean Standard Classification of Diseases-7).ResultsA total of 26 primary care physicians from 23 primary care clinics participated in the study. Furthermore, 2,458 ICD-10 codes and 6,091 ICPC-2 codes were recorded from the data of 1,099 patients. The common disease codes were vasomotor and allergic rhinitis (J30), according to ICD-10, and acute upper respiratory infection (R74) in ICPC-2. Comparing disease status by body systems, the proportion of gastrointestinal disease with ICD-10 codes was significantly higher than that with ICPC-2 codes (P<0.001). Furthermore, patients with >4 diagnoses accounted for 36% of the ICD-10 classifications, whereas those with >4 diagnoses accounted for 4% of the ICPC-2 classifications.ConclusionIntroducing ICPC as a complementary means for diagnosing common diseases could be a practical approach in Korean primary care.

Middle meatus nasal cytology compared to inferior turbinate cytology in non allergic rhinitis.

Non allergic rhinitis (NAR) comprises different clinical definitions and phenotypes, including non inflammatory non allergic (NINAR) and cellular inflammatory forms. Nasal cytology, usually performed by scraping the inferior turbinate, is a non invasive, cheap and point-of-care tool to distinguish among the different NAR phenotypes, but still a relevant proportion of patients evaluated by nasal cytology receive a non precise definition of NAR phenotype. We hypothesize that collecting nasal cytology samples from middle meatus could increase the diagnostic accuracy. Consecutive patients with chronic rhinitis without evidence of allergic sensitization were assessed for nasal cytology by means of scraping both the inferior turbinate and the middle meatus (lateral-inferior wall of the middle turbinate). 107 consecutive patients with NAR were enrolled in the study. According to inferior turbinate cytology, 42.1% were defined as affected by NINAR, 2.8% by bacterial rhinitis, 10.3% by non allergic rhinitis with eosinophils (NARES), 15.0% non allergic rhinitis with neutrophils (NARNE), 19.6% non allergic rhinitis with mast-cells (NARMA) and 10.3% non allergic rhinitis with eosinophils and mast-cells (NARESMA). Middle meatus cytology was in accordance with inferior turbinate cytology in only 37.6% of cases. Eosinophils and mast-cells were detectable more frequently in middle meatus samples (49.5% vs 19.6%, p < 0.01, 59.8% vs 29.9%, p < 0.01, respectively). 93.3% of NINAR patients received an inflammatory NAR phenotype at middle meatus cytology: 26.7% NARES, 24.4% NARNE, 31.1% NARMA and 11.1% NARESMA. Middle meatus cytology is more reliable than inferior turbinate cytology in phenotyping patients with NAR. Our study strengthen that nasal cytology should be implemented in clinical practice collecting samples at the middle meatus level.

Scraping nasal cytology in the diagnostics of rhinitis and the comorbidities

Nasal scraping cytology is a non-invasive tool used in the diagnostics of allergic and non-allergic rhinitis. The study aimed to analyze to what extent the cytological picture of the nasal mucosa coincides with the diagnosis of a given disease, taking into account the content of eosinophils. Retrospective analysis of the cytograms performed in 842 patients was carried out in relation to the disease entities and the content of eosinophils. Significant relationship between the Epith:Infl ratio and the four groups of diseases (Chi2 = 9.6488; p = .014) was confirmed. The more intensive inflammation was found, the higher percentage of patients had manifested the increased level of eosinophils (> 1% in the inflammatory cells). The value of 20% of eosinophils in all counted cells corresponds to around 45% of eosinophils in the inflammatory cells in patients with the evident inflammatory picture. Allergic rhinitis presents a different cytological picture regarding the eosinophilic reaction against the background of the inflammation process: the higher degree of inflammation observed, the lower amount of eosinophils detected, with the exception of allergic rhinitis provoked by pollen allergens.

Impact of Air Pollutants and Pollen on the Severity of Nonallergic Rhinitis: A Data-Oriented Analysis.

BackgroundRhino-conjunctivitis symptoms are more severe in nonallergic rhinitis (NAR) patients during pollen season than in other seasons. Little is known about the role of pollen and air pollutants on the severity of NAR.ObjectiveThe aim of this study is to assess the cross-sectional effects of both pollen and air pollutants on NAR patients during the pollen and non-pollen seasons, and to further explore the possible relationship among these triggers.MethodsA total of 2411 clinically diagnosed NAR outpatients from 2018 to 2019 were recruited for this study. The severity of NAR was measured using rhinoconjunctivitis symptom scores. Associations of daily exposure to pollen, PM2.5, PM10, NO2, SO2, CO, O3, and rhinoconjunctivitis symptom scores were evaluated using Logistic regression models. Distributed Lag Nonlinear models were used to explore single-day and accumulative Lag effects of environmental factors mentioned above.ResultsDuring the pollen season, pollen concentration, higher exposure levels of PM10, PM2.5, NO2, and SO2 increased the severity of NAR group when compared with the low-moderate severity group. The high severity group was associated with lower exposure levels of O3. However, during non-pollen seasons, no significant association was found in air pollutant metrics, pollen concentration, and severity of NAR. The exposure-severity effects of pollen were different when different ambient pollutants were stratified.ConclusionSynergistic effect of pollen and air pollutants, including PM2.5, PM10, SO2, NO2, and O3, might be responsible for aggravating the symptoms of NAR patients during pollen seasons.

Calprotectin in nasal secretion: a new biomarker of non-type 2 inflammation in CRSwNP.

SUMMARYObjectiveWe analysed calprotectin in sinonasal secretions of different chronic rhinosinusitis with nasal polyps (CRSwNP) endotypes to assess its role as a biomarker of non-type 2 inflammation.MethodsWe included primary diffuse CRSwNP patients (n = 41) and three different control groups [non-allergic rhinitis (NAR) (n = 13), non-allergic eosinophilic syndrome (NARES) (n = 10) and healthy subjects (n = 12)]. Calprotectin levels were detected in nasal secretions using a chemiluminescent immunoassay (CLIA).ResultsCalprotectin levels in nasal secretions were significantly higher in all non-type 2 endotypes of CRSwNP compared to healthy controls (p < 0.05). In contrast, in type-2 CRSwNP calprotectin was significantly lower compared to controls (p < 0.05). A significant correlation between calprotectin levels and neutrophilic count/HPF was found in CRSwNP (p < 0.01). Clinically, mean levels of calprotectin and neutrophilia were significantly higher in patients who previously underwent 3 or more endoscopic sinus surgeries (p < 0.05).ConclusionsCalprotectin in nasal secretions may be a biomarker of non-type 2 inflammation. Low levels of calprotectin are indicative of a type-2 immune response in both CRSwNP and non-allergic rhinitis. We observed that calprotectin levels significantly increased based on the number of previous surgeries.

A vidian neurectomy approach with the sphenoid process of the palatine bone as a landmark

Objective:To explore a safe and effective surgical approach to locate and cut the vidian nerves with the sphenoid process of the palatine bone as a landmark. Methods: The landmarks of locating the external opening of the vidian canal were confirmed by the dissection of the cadaveric heads, and the feasibility of locating the vidian nerves with the determined landmarks was verified during operation. Results:The anatomical landmarks, which are the anterior opening of palatovaginal canal, the posterior opening of palatovaginal canal, palatovaginal canal and the nasal pharyngeal crest of the root of the pterygoid process can be used as the important landmarks of locating vidian nerve. In the cases of 10 patients with refractory allergic rhinitis and vasomotor rhinitis, the vidian nerves were successfully located and sectioned, and one patient was complicated with short-term unilateral palatal numbness after surgery. Conclusion:The anterior opening of palatovaginal canal, the posterior opening of palatovaginal canal, palatovaginal canal and the nasal pharyngeal crest of the root of the pterygoid process can be used as surgical markers for vidian neurectomy with the sphenoid process of the palatine bone as landmarks.

Treatment of inferior turbinate hypertrophy by plasma turbinate reduction with one-point-three-side way.

Nasal congestion is often the main symptom of the patients with non-allergic rhinitis, who have inferior turbinate hypertrophy if getting poor treatment effect. Plasma treatment for inferior turbinate hypertrophy can effectively improve nasal obstruction. Generally, plasma treatment with multiple puncture sites, makes patients intraoperative painful and postoperative bleeding, which let patients often fear of surgery. Postoperative nasal adhesion or lower turbinate scar and other complications sometimes happened, and some patients still feel nasal obstruction due to severe mucosal damage and scar formation. We innovatively used one-point-three-side plasma turbinate volume reduction in the treatment of inferior turbinate hypertrophy, in order to reduce complication, improve symptoms, and enhance curative effect. A total of 111 patients with non-allergic rhinitis with complete data due to hypertrophy of inferior turbinate and poor drug treatment from Nov. 2011 to Oct. 2019. The hypertrophic inferior turbinate of patients with non-allergic rhinitis was ablated by plasma turbinate volume reduction, and the symptom scores of patients were evaluated by visual analog scales (VAS) before surgery, 1 week, 1 month, 3 months, and 6 months after surgery. The intraoperative pain was scored by VAS. The pathological morphology of nasal mucosa was observed before and after operation in some patients. The nasal obstruction score of the patients was significantly lower at 1 week, 1 month, 3 months and 6 months after the operation (all P<0.05). The distribution of submucosal blood vessels and glands was improved by postoperative pathological observation. Plasma turbinate volume reduction with one-point-three-side is effective with minimally invasion, and less complication, which is worthy of clinical promotion.

Nasal drug delivery for Chronic Rhinosinusitis: An Overview

Nasal delivery is the logical choice for topical treatment of local diseases in the nose and Paranasal sinuses such as allergic and non-allergic rhinitis and sinusitis. The nose is also considered an attractive route for needle-free vaccination and for systemic drug delivery, especially when rapid absorption and effect are desired. In addition, nasal delivery may help address issues related to poor bioavailability, slow absorption, drug degradation, and adverse events in the gastrointestinal tract and avoids the first-pass metabolism in the liver. However, when considering nasal delivery devices and mechanisms, it is important to keep in mind that the prime purpose of the nasal airway is to protect the delicate lungs from hazardous exposures, not to serve as a delivery route for drugs and vaccines. The narrow nasal valve and the complex convoluted nasal geometry with its dynamic cyclic physiological changes provide efficient filtration and conditioning of the inspired air, enhance olfaction, and optimize gas exchange and fluid retention during exhalation. However, the potential hurdles these functional features impose on efficient nasal drug delivery are often ignored. With this background, the advantages and limitations of existing and emerging nasal delivery devices and dispersion technologies are reviewed with focus on their clinical performance. The role and limitations of the in vitro testing in the FDA guidance for nasal spray pumps and pressurized aerosols (pressurized metered-dose inhalers) with local action are discussed. Moreover, the predictive value and clinical utility of nasal cast studies and computer simulations of nasal airflow and deposition with computer fluid dynamics software are briefly discussed. New and emerging delivery technologies and devices with emphasis on BiDirectional™ delivery, Keywords Drug delivery Nasal Device Paranasal sinuses Topical Systemic Vaccine Nasal valve Particle deposition Clearance

Application of Three Dimensional-Printed Polycaprolactone Nasal Mesh With the Figure of 8 Anchoring Suture Technique for Correction of Caudal Septal Subluxation

Background and Objectives We evaluated the symptom improvement, surgical outcomes and post-operative complications of the figure of 8 anchoring suture technique using polycaprolactone (PCL) nasal mesh for the treatment of caudal septal subluxation.Subjects and Method We conducted a retrospective study of patients who underwent between March 2020 and March 2021 endonasal septoplasty using the figure of 8 anchoring suture technique and a PCL nasal mesh as a protective supporting graft. Fourteen patients were divided into two groups, the allergic and non-allergic rhinitis group. Symptom improvements were assessed using the Nasal Obstruction Symptoms Evaluation (NOSE) scores and visual analog scale (VAS) scores for epistaxis and headache. Post-operative patient-reported subjective changes in nasal obstruction were also recorded. All evaluations were conducted one to four months post-operatively.Results Post-operative endoscopic examination revealed that all patients had their septum straightened. The mean post-operative NOSE scores in overall and each item were significantly lower than the mean NOSE scores in the pre-operative period (p&lt;0.05). The mean post-operative NOSE scores for patients both with and without allergic rhinitis were also significantly decreased compared to those in the pre-operative period (p&lt;0.05). A decrease in VAS scores was significant (p=0.008) for headache but not for epistaxis (p=0.141). All patients reported improvement of subjective nasal obstruction post-operatively.Conclusion The use of figure of 8 anchoring suture technique with a PCL nasal mesh as a protective and supportive graft was proven to be a successful method for correcting caudal septal subluxation.

Mometasone Furoate in Non-Allergic Rhinitis: A Real-Life Italian Study

Background: In order to evaluate the efficacy of intranasal mometasone furoate in patients with non-allergic rhinitis (NAR), a real-life, observational, prospective study is performed. Methods: Thirty-one patients (age 18–64 years) receive intranasal (mometasone furoate, 200 µg b.i.d. for 15 consecutive days per month for 6 consecutive months), plus isotonic nasal saline. The cytologic pattern of local inflammation, nasal airflow, through peak nasal inspiratory flow (PNIF), quality of life (QoL), through the rhinitis quality of life questionnaire (RQLQ), the sinonasal outcome test (SNOT-22), the short-form 36-item health survey (SF-36v2), and the combined symptom medication score (CSMS), and, finally, olfactory function, through Sniffin’ sticks-16 identification test (SSIT-16), are evaluated at baseline and after treatment. Results: NARNE is the most frequent cytological pattern (48% of the total sample). The therapeutic response shows improvement in olfactory function and QoL. Conclusions: The results of this study confirm that intranasal mometasone furoate is an effective treatment for patients with NAR.

Intranasal Anticholinergics for Treatment of Chronic Rhinitis: Systematic Review and Meta-Analysis.

Topical intranasal anticholinergics are commonly prescribed for the relief of chronic rhinitis and associated symptoms, warranting thorough assessment of the supporting evidence. The present study aimed to evaluate the safety and efficacy of anticholinergic nasal sprays in the management of allergic and non-allergic rhinitis symptom severity and duration. A search encompassing the Cochrane Library, PubMed/MEDLINE, and Scopus databases was conducted. Primary studies describing rhinorrhea, nasal congestion, and/or postnasal drip outcomes in rhinitis patients treated with an anticholinergic spray were included for review. The search yielded 1,029 unique abstracts, of which 12 studies (n=2,024) met inclusion criteria for qualitative synthesis and 9 (n=1,920) for meta-analysis. Median follow-up was 4 weeks and ipratropium bromide was the most extensively trialed anticholinergic. Compared to placebo, anticholinergic treatment was demonstrated to significantly reduce rhinorrhea severity scores (standardized mean difference [95% CI]=-0.77 [-1.20, -0.35]; -0.43 [-0.72, -0.13]) and duration (-0.62 [-0.95, -0.30]; -0.29 [-0.47, -0.10]) in allergic and non-allergic rhinitis patients respectively. Benefit was less consistent for nasal congestion, postnasal drip, and sneezing symptoms. Reported adverse effects included nasal mucosa dryness or irritation, epistaxis, headaches, and pharyngitis, though comparison to placebo found significantly greater risk for epistaxis only (risk ratio [95% CI]=2.19 [1.22, 3.93]). Albeit treating other symptoms with less benefit, anticholinergic nasal sprays appear to be safe and efficacious in reducing rhinorrhea severity and duration in both rhinitis etiologies. This evidence supports their continued use in the treatment of rhinitis-associated rhinorrhea. 1 Laryngoscope, 133:722-731, 2023.

Local and systemic adverse reactions following COVID-19 vaccine

The mass vaccination against novel coronavirus infection (COVID-19) requires to dynamically evaluate risks of adverse events following immunization to prevent them and develop vaccination tactics for various population groups. We describe a clinical case of reaction following administration of the second dose of the heterologous recombinant adenovirus based COVID-19 vaccine Gam-COVID-Vac (Sputnik V) in 48-year-old female healthcare worker. No adverse events after administration of the first dose were recorded. After vaccination, the patient complained of weakness, malaise, headache, loss of appetite, and nausea that lasted for a single day. Reaction at the injection site appeared 10 hours after vaccination manifested as pruritic erythema, induration area up to 1.5 cm size, sharp pain, which resolved within 24 hours. On the second day post-vaccination, an inflammation area up to 1.5 cm size within the Bacillus CalmetteGurin (BCG) scar site was noted and manifested as erythema, induration, painful to palpate, pruritus located 2 cm away from the injection site. BCG scar reaction with dull pain and severe pruritus lasted for three weeks. Erythema and induration at the BCG scar site resolved two months after the onset, which were resolved by using antihistaminic agent. The patient was vaccinated according to the Russian Federation Immunization Program, not associated with any adverse events following immunization. The patient had comorbidities such as vasomotor rhinitis, urolithiasis, stomach, duodenal ulcer, type 2 diabetes, arterial hypertension, and her body mass index of 35.2. The patient permanently receives antihypertensive and antihyperglycemic drugs, and has allergic reaction in the form of urticaria to Berodual. The patient has menopause during two years, but a five-day postmenopausal bleeding three days after vaccination with the second dose was noted. Thus, a high-quality surveillance of any local and systemic reactions associated with vaccination is needed to reveal adverse events to the vaccines against COVID-19 and elaborate a safe immunization program for preventing COVID-19.

Brief overview on vasomotor rhinitis and its utility from repertory of the homoeopathic materia medica by J.T. Kent

Vasomotor Rhinitis (VMR) is one of the type of Non-Allergic Rhinitis which is not related to infections, allergy, drug abuse, systemic lesions or structural problems in disease. It comprises 71% of all non allergic rhinitis and it is the most common form of Non-Allergic Rhinitis (NAR). This disease prevalence is estimated to 320 million approaching worldwide. According to the epidemiological data of Rhinitis, the ratio between Allergic Rhinitis (AR) and Non- Allergic Rhinitis is 3:1 [1] VMR presents in adulthood between 20-60 years of age group. Females are more commonly affected than men. VMR is triggered by conditions of environment such as strong smell, exposure to the cold air from air conditioner, weather change, temperature change, cold air exposure, humidity changes, intake of alcoholic beverages and stress [2, 12] VMR is misdiagnosed often as Allergic Rhinitis most of the time and leads to improper medications which ultimately result in failure of treatment in this specific type of Rhinitis – and becomes a challenge for modern medicine. But Homoeopathic practitioners try to bring out good improvement in VMR as they select medicine based on symptom similarity and individuality of the patient. VMR has several mental and physical triggers without involvement of IgE (Non-Allergic reaction) and with internal and external environmental surrounding of the individual. Even in this modern era, Kent repertory is most commonly used and one among the trusted Repertory. VMR rubrics are found under the chapter Nose, mind and Generalities of Kent Repertory. Kent Repertory follows deductive logic (General symptom to particular symptom) and the individualisation concept is achieved by considering the patient’s totality i.e considering the patient as a whole.

The relative proportion of comorbidities among rhinitis and rhinosinusitis patients and their impact on visit burden.

BackgroundThe aim was to evaluate the relative proportion of Non‐steroidal anti‐inflammatory drug exacerbated respiratory disease (NERD) and other comorbidities, and their impact on the burden of outpatient visits due to allergic rhinitis (AR), non‐allergic rhinitis (NAR), acute rhinosinusitis (ARS), and chronic rhinosinusitis with nasal polyps (CRSwNP) and without (CRSsNP).MethodsWe used hospital registry data of a random sample of 5080 rhinitis/rhinosinusitis patients diagnosed during 2005–2019. International Statistical Classification of Diseases and Related Health Problems (ICD10) diagnoses, visits, and other factors were collected from electronic health records by using information extraction and data processing methods. Cox's proportional hazards model was used for modeling the time to the next outpatient visit.ResultsThe mean (±standard deviation) age of the population was 33.6 (±20.7) years and 56.1% were female. The relative proportion of AR, NAR, ARS, CRSsNP and CRSwNP, were 33.5%, 27.5%, 27.2%, 20.7%, and 10.9%, respectively. The most common other comorbidities were asthma (44.4%), other chronic respiratory diseases (38.5%), musculoskeletal diseases (38.4%), and cardiovascular diseases (35.7%). Non‐steroidal anti‐inflammatory drug exacerbated respiratory disease existed in 3.9% of all patients, and 17.7% of the CRSwNP group. The relative proportion of subjects having 1, 2, 3 and ≥ 4 other diseases were 18.0%, 17.6%, 17.0%, 37.0%, respectively. All diseases except AR, ARS, and mouth breathing, were associated with a high frequency of outpatient visits.ConclusionsOur results revealed a high relative proportion of NERD and other comorbidities, which affect the burden of outpatient visits and hence confirm the socioeconomic impact of upper airway diseases.

The Beneficial Effects of Hydrogen-Rich Saline Irrigation on Chronic Rhinitis: A Randomized, Double-Blind Clinical Trial

PurposeChronic rhinitis (CR) is a common chronic inflammation of the nasal mucosa. Nasal saline irrigation has been demonstrated to be an effective treatment for CR. In this study, we investigated the beneficial effects of hydrogen-rich saline irrigation as an anti-inflammatory irrigation therapy for CR and compared its effectiveness over saline irrigation. Hydrogen-rich saline (HRS) was investigated due to its antioxidant and anti-inflammatory properties.MethodsA total of 120 patients with CR were randomly divided into two groups, patients irrigated with HR (HRS group) and the control group irrigated with saline (NS group). A randomized, double-blind control study was performed. The main observation index in this study was the total score of nasal symptoms (TNSS). In addition, eosinophilic protein (ECP) of the nasal secretions, nasal nitric oxide (nNO) levels, and levels of regulatory T cells (Treg) and regulatory B cells (Breg) were also compared between the two groups. Furthermore, patients with allergic rhinitis (AR) and non-allergic rhinitis (NAR) were also evaluated based on serum-specific IgE positivity.ResultsAfter treatment, TNSS and nasal ECP in the two groups decreased significantly (P<0.05), with patients in the HRS group showing significantly lower levels compared to the NS group (P<0.05). There were no significant differences in Treg and Breg levels between the two groups. Subgroup analysis showed that TNSS in the AR-HRS group showed a more significant reduction compared to the AR-NS group (P<0.05); however, there were no significant differences for the other inflammatory biomarkers (P>0.05). ECP levels were reduced significantly in the NAR subgroup compared to NS irrigation (P<0.05). There were no obvious adverse events observed in patients during the entire treatment period.ConclusionCompared to saline irrigation, HRS nasal irrigation was found to improve CR clinical symptoms, especially in patients with AR. HRS could effectively be used for the clinical treatment of patients with CR.