Obstructive Allergic Rhinitis Research Articles

Observational Study on the Effects of Submucosal Diathermy on Chronic Nasal Obstruction in Allergic Rhinitis

Observational Study on the Effects of Submucosal Diathermy on Chronic Nasal Obstruction in Allergic Rhinitis

Potential synergistic effects of novel hematopoietic prostaglandin D synthase inhibitor TAS-205 and different types of anti-allergic medicine on nasal obstruction in a Guinea pig model of experimental allergic rhinitis

Nasal obstruction is one of the most bothersome symptoms of allergic rhinitis (AR) affecting sleep-related quality of life in AR patients. Although several treatments were tested to control nasal obstruction, some patients with moderate to severe AR do not respond to current treatments, including the combined administration of different types of anti-allergic medicine. Thus, new options for AR treatment are needed. This study aimed to evaluate the effects of combined treatment with a novel inhibitor of hematopoietic prostaglandin D synthase (HPGDS), TAS-205, and different types of anti-allergic medicine on nasal obstruction in AR. Firstly, we demonstrated that TAS-205 selectively inhibited prostaglandin D2 (PGD2) synthesis in an enzymatic assay in a cell-based assay and in vivo models of AR. Moreover, treatment with TAS-205 alone suppressed eosinophil infiltration into the nasal cavity and late phase nasal obstruction. The combined administration of TAS-205 with montelukast, a cysteinyl leukotriene receptor 1 antagonist, showed significant additive inhibitory effects on eosinophil infiltration and late phase nasal obstruction compared to treatment with each agent alone. In contrast, concomitant treatment with TAS-205 and fexofenadine, a histamine H1 blocker, showed inhibitory effects on late phase and early phase nasal obstruction, although the magnitude of the inhibitory effects upon combined administration was comparable to that of each single treatment. These results suggest that combined treatment with an HPGDS inhibitor and different types of anti-allergic medicine may be a promising strategy to control nasal obstruction in AR patients.

The mechanism and treatment of nasal obstruction in allergic rhinitis

SummaryNasal obstruction is one of the main symptoms of allergic rhinitis（AR） as well as one of the most common complains in the otolaryngology department. Among the many causes of nasal congestion, such as inflammation and anatomy, the most common clinical cause is the nasal mucosal inflammatory response that caused by AR. The nasal congestion caused by AR can induce nighttime sleep disturbance and mental-psychological burden. Nasal congestion has a greater impact on children, which can directly affect growth and development due to affecting nighttime sleep, and may even affect maxillofacial development, which should be paid special attention by physicians. According to the particularity of AR nasal congestion, this review summarizes how to carry out clinical consultation, select specialist examination and objective examination methods, and develop the optimal treatment strategy.

Comparative study between partial inferior turbinectomy and submucosal diathermy for treatment of inferior turbinate hypertrophy due to allergic rhinitis

<p class="abstract"><strong>Background:</strong> Nasal obstruction due to inferior turbinate hypertrophy is one of the most common symptoms of Allergic rhinitis (AR) which causes significant debility. Surgery is one of the modalities of treatment to relieve patients of nasal obstruction. Objective of the study was to evaluate the efficacy of submucosal diathermy (SMD) and partial inferior turbinectomy (PIT) in the treatment of hypertrophied inferior turbinate.</p><p class="abstract"><strong>Methods:</strong> Sixty patients with allergic rhinitis and hypertrophied inferior turbinates were randomised into two groups with thirty patients each (group I underwent SMD and group II underwent PIT). They were assessed for relief of nasal obstruction by subjective and objective methods. </p><p class="abstract"><strong>Results:</strong> Nasal obstruction due to hypertrophy of inferior turbinate was the main symptom with 45 (75%) patients having severe obstruction and 15 (25%) patients moderate obstruction. Both the surgical procedures were effective in reducing nasal obstruction & other symptoms of AR. Though the total symptom score was significantly reduced by both the methods (p=0.001) SMD was superior in relieving nasal obstruction at 3months follow up while PIT was more effective at 6 months follow up.</p><p class="abstract"><strong>Conclusions:</strong> SMD is an easier, less invasive method with lesser postoperative discomfort and complications as compared to PIT. Our study recommends SMD as an effective technique for relief of nasal obstruction in allergic rhinitis.</p>

Nasal Peak Inspiratory and Expiratory Flow Measurements for Assessing Nasal Obstruction in Allergic Rhinitis

Although nasal peak flow measurements have been proposed as a simple alternative method to assess nasal patency, which of nasal peak expiratory flow or nasal peak inspiratory flow (NPEF/NPIF) or the peak expiratory flow index or peak inspiratory flow index (PEFI/PIFI; the ratios between nasal and oral PEF or nasal and oral PIF, respectively) is the more accurate method is unclear. The aim of this study was to evaluate the correlation between NPEF, NPIF, PEFI, and PIFI, and blocked nose score (BNS) and mucociliary clearance time (MCCT) in diagnostic and follow-up assessments. Ninety-nine allergic rhinitis (AR) patients were treated with 220 micrograms once daily of intranasal triamcinolone acetonide for 28 days. BNS, NPEF, NPIF, PEFI, and PIFI and MCCT were used to evaluate treatment outcome. Correlations of initial visit scores and score changes after treatment between peak flow rates and BNSs and MCCTs were analyzed. All nasal symptoms, peak flows, and MCCTs showed statistically significant improvements after the nasal steroid treatment. PEFI showed the best negative correlation with BNS and MCCTs, followed by PIFI, NPEF, and NPIF. Nasal peak flows showed better correlations with MCCTs than BNSs. Mean changes of peak flow rates between visits showed better correlation with BNSs and MCCTs than absolute values of peak flow rates at the initial visit. Among nasal peak flow measurements, PEFI is the most appropriate objective tool for assessing nasal patency in AR. Peak flows can indicate underlying mucosal inflammation and are more sensitive to assess score changes after treatment than cross-sectional assessment at the initial visit.

Nasal nitric oxide is dependent on sinus obstruction in allergic rhinitis

The aim of this study was to evaluate the associations between nasal nitric oxide and nasal symptoms, sinus opacification, and markers of allergic inflammation in allergic and in nonallergic rhinitis while taking into account the effect of sinus obstruction. We studied 175 young adult subjects divided into three groups: 1) allergic rhinitis, 2) nonallergic rhinitis, and 3) controls. We measured nasal nitric oxide using the breath-holding method and exhaled nitric oxide and scored semiquantitatively nasal computed tomography scans for opacification and obstruction. We also assessed the visual analogue scores of nasal symptoms, eosinophil count, and interleukin-13 mRNA levels in nasal biopsies. The level of nasal nitric oxide correlated with exhaled nitric oxide (r = 0.377, P < .001). In allergic rhinitis, nasal nitric oxide was elevated when compared to the controls, and an inverse correlation existed between the nasal nitric oxide level and sinus ostial obstruction (r = -0.272, P = .013). In nonallergic rhinitis, the level of nasal nitric oxide was similar to that of the controls. In allergic rhinitis, nasal nitric oxide correlated positively with the opacification score (r = 0.250, P = .033) and the nasal eosinophil count (r = 0.293, P = .030) of patients without a marked sinus ostial obstruction. Sinus ostial obstruction lowers the level of nasal nitric oxide and reduces its value as an indicator of allergic mucosal inflammation. A high nasal nitric oxide level may be a useful marker of eosinophilic inflammation in the nasal cavity and indicate the absence of marked sinus ostial obstruction. 3b.

Subclinical airflow obstruction in allergic rhinitis.

Subclinical airflow obstruction in allergic rhinitis.

Short‐time cold dry air exposure: A useful diagnostic tool for nasal hyperresponsiveness

Demonstration of nasal hyperreactivity (NHR) in allergic and nonallergic rhinitis remains a diagnostic challenge because of the lack of a clinically attractive protocol with high sensitivity and specificity. Our aim was to evaluate the feasibility of a shortened cold dry air (CDA) provocation protocol for the diagnosis of NHR in patients with allergic rhinitis (AR) and idiopathic rhinitis (IR). Twelve AR patients, 12 IR patients, and 12 controls were exposed to air at -10°C and <10% humidity for 15 minutes. Nasal symptoms were subjectively evaluated by visual analogue scale (VAS), and nasal obstruction was objectively measured by peak nasal inspiratory flow (PNIF) before and after CDA exposure. NHR was defined as a drop in PNIF larger than 20% from baseline upon CDA challenge. Nasal CDA exposure induced nasal obstruction in AR and IR patients but not in controls. The VAS for nasal obstruction increased significantly in IR patients (post-CDA: 9.1 cm [6.9, 9.7] vs. pre-CDA: 5.5 cm [5.0, 8.9], P = .004) as well as in AR patients (post-CDA: 5.0 cm [1.3, 6.6] vs. pre-CDA: 0.8 cm [0.0, 1.7], P = .001). PNIF values showed a significant decrease in the AR (post-CDA: 50.0 L/min [37.5, 97.5] vs. pre-CDA: 95.0 L/min [52.5, 127.5], P = .002) and IR (post-CDA: 75.0 L/min [47.5, 102.5] vs. pre-CDA: 100.0 L/min [67.5, 130.0], P = .002) group after CDA provocation, which was not observed in the controls (P = 1.000). The sensitivity and specificity of CDA provocation for diagnosis of NHR were 66.7% and 100%, respectively, for both IR and AR. In contrast to nasal obstruction, rhinorrhea and sneezing were not induced by CDA exposure. This study demonstrates that a short nasal CDA exposure is a reliable method for the diagnosis of NHR in rhinitis patients, with a high sensitivity and specificity.

Comparison of Nasal Sound Spectral Analysis and Peak Nasal Inspiratory Flow before and after Decongestion in Patients with Nasal Obstruction

We compared the results of nasal sound spectral analysis (NSSA) with the results of peak nasal inspiratory flow (PNIF) testing and use of a visual analog scale in patients with allergic rhinitis with nasal obstruction. We performed NSSA and PNIF testing on 38 patients with allergic rhinitis and 35 healthy subjects. A diagnostic decongestion test was performed on the patients (not on the control subjects). Twenty minutes after decongestant was sprayed into the nostrils, NSSA and PNIF testing were performed again. There was a significant difference in the PNIF values and the nasal inspiratory sound intensities before and after decongestion (p < 0.001). There was a correlation between the NSSA results at the frequency range of 2 to 4 kHz and the PNIF results. The calculated cutoffs between normal and pathological values were 14.8 dB (2 to 4 kHz) for NSSA and 116 +/- 14.1 L/min for PNIF testing. No significant differences were computed between NSSA and PNIF testing in terms of sensitivity (0.71 versus 0.76) or specificity (0.74 versus 0.80). Use of NSSA and PNIF testing together for assessment of nasal obstruction in allergic rhinitis provides clinical relevance in that it allows a fair degree of reliability. Such testing can be performed as a surrogate for rhinomanometry.

Role of hematopoietic prostaglandin D synthase in biphasic nasal obstruction in guinea pig model of experimental allergic rhinitis

We investigated the role of hematopoietic prostaglandin D synthase (H-PGDS) in biphasic nasal obstruction in allergic rhinitis using a new specific inhibitor, (N-methoxy-N-methyl)-4-(5-benzoylbenzimidazole-2-yl)-3,5-dimethylpyrrole-2-carboxamide hydrochloride (TAS-204). First, we developed a novel guinea pig model of allergic rhinitis. Guinea pigs sensitized to ovalbumin without adjuvant were challenged with intranasal exposure to ovalbumin once a week. After the 3rd antigen challenge, they exhibited biphasic nasal obstruction. Additionally, analysis of nasal lavage fluid revealed an increase in the level of prostaglandin D 2 in both early and late phases. Treatment with oral TAS-204 for 15 days during the period of antigen challenges suppressed increases in nasal airway resistance in both phases. It is noteworthy that the late phase nasal obstruction was almost completely abrogated by inhibiting H-PGDS alone. Eosinophil infiltration in nasal lavage fluid and nasal hyperresponsiveness to histamine was also reduced by TAS-204 administration. These findings suggest that H-PGDS plays a critical role in the development of allergic rhinitis, especially in the induction of late phase nasal obstruction.

Inferior turbinate surgery for nasal obstruction in allergic rhinitis after failed medical treatment

Allergic rhinitis is a highly prevalent disease that results from an IgE-mediated hypersensitivity reaction of the nasal mucosa to inhaled allergens.It is primarily treated by allergen avoidance and medical treatment, but when these measures fail to control symptoms then surgery to the inferior turbinates of nose is often performed. It is unclear whether these procedures are beneficial in the long term or indeed whether the risks outweigh the benefits. To assess the effectiveness of inferior turbinate surgery on unrelieved or partially relieved nasal obstruction in patients after maximal medical treatment of proven allergic rhinitis, to compare the results using different surgical techniques and to measure short and long-term results. We searched the following databases from their inception for published, unpublished and ongoing trials: the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2); PubMed; EMBASE; CINAHL; LILACS; KoreaMed; IndMed; PakMediNet; CAB Abstracts; Web of Science; BIOSIS Previews; CNKI; mRCT (Current Controlled Trials); ClinicalTrials.gov; ISRCTN; ICTRP (International Clinical Trials Registry Platform); Cambridge Scientific Abstracts; Google and additional sources for published and unpublished trials. We modelled subject strategies for databases on the search strategy designed for CENTRAL. The date of the most recent search was 6 July 2010. Randomised controlled trials of inferior turbinate surgery versus continued medical treatment for proven allergic rhinitis, or comparisons between one technique of inferior turbinate surgery versus another technique, after maximal medical treatment. Both authors independently screened the search results and assessed the full text of potentially relevant studies. We attempted to contact trial authors for additional information. There were no studies that fulfilled the inclusion criteria of the review. This review highlights the need for randomised controlled trials to evaluate the role of inferior turbinate surgery for nasal obstruction in allergic rhinitis after failed medical treatment. Future trials needs to be rigorous in design and delivery, separate adults from paediatric patients, not combine allergic with non-allergic patients and last long enough to determine long-term results and complications.

Coblation turbinate reduction in childhood allergic rhinitis

Nasal obstruction is the allergic rhinitis symptom least amenable to medical treatment, and inferior turbinectomy may be required. Coblation is a minimally invasive technique that is effective in obstruction secondary to inferior turbinate hypertrophy. The present study assessed efficacy in children presenting with obstructive allergic rhinitis after failure of medical management. This prospective study included nine children with allergic rhinitis. Coblation was performed after assessment of rhinitis. Obstruction was assessed on rhinomanometry and a visual analog scale; other rhinologic functional signs were assessed on interview, and functional impact was assessed on the PRQLQ quality of life questionnaire. After the procedure, all nine children showed reduced nasal obstruction and improved rhinologic function signs, confirmed by the favorable evolution of PRQLQ scores. The study demonstrated the interest of coblation in controlling nasal obstruction in children with allergic rhinitis refractory to medical treatment, with conserved nasal function. Larger-scale studies with longer follow-up will be needed to confirm these results.

Involvements of cysteinyl leukotrienes and nitric oxide in antigen-induced venodilatation of nasal mucosa in sensitized rats in vivo

To determine an in vivo venodilatation of nasal mucosa, which is thought to be one of the causes of nasal obstruction in allergic rhinitis, venous diameters of nasal septa were directly measured in anesthetized rats. An application of antigen to nasal mucosa of sensitized rats caused an increase in diameters of mucosal veins, that is, venodilatation: the maximal response (about 20% increase in diameters) was observed at 55 min after antigen challenge. The antigen-induced increase in venous diameter of nasal mucosa was significantly inhibited by pretreatment with a cysteinyl leukotrienes (CysLTs) receptor antagonist, SR2640, and a nitric oxide (NO) synthase inhibitor, N(G)-monomethyl-L-arginine, indicating that CysLTs and NO might be involved in the venodilatation of nasal mucosa induced by antigen challenge. Blocking the action of CysLTs and NO might be therefore useful for the therapy of nasal obstruction in allergic rhinitis.

Nasal Sound Analysis: A New Method for Evaluating Nasal Obstruction in Allergic Rhinitis

Current measurements of nasal obstruction are unreliable and may be improved with the development of new techniques. The effectiveness of odiosoft-rhino (OR) in the evaluation of nasal obstruction was investigated in a blind comparison at a referral center, institutional practice. Forty-eight patients with perennial allergic rhinitis and 52 healthy subjects were studied. Nasal endoscopic examination, acoustic rhinometry (AR), and OR were performed and symptom scores compared. Assessment of nasal blockage with OR method was the main outcome measure. Using the OR technique, significant differences were observed between the patient and control groups. OR data correlated with symptom scores and endoscopic examination. However, this was not observed with AR. A 15.5-dB cutoff point for the left side and 14.5 dB cutoff point for the right side at the 2,000 to 4,000 Hz frequency interval resulted in 93.8% sensitivity and 92.3% specificity and 72.9% sensitivity and 80.8% specificity, respectively. A 8.5-dB cutoff point for the left and right sides at the 4,000 to 6,000 Hz frequency interval resulted in 87.5% sensitivity and 80.8% specificity and 70.8% sensitivity and 78.8% specificity, respectively. OR is a simple, noninvasive test for assessing nasal obstruction. The OR technique can detect nasal obstruction with high sensitivity and specificity, and these findings correlate with symptoms and physical examination.

Impaired Norepinephrine-Mediated Contraction of Isolated Nasal Mucosa in Guinea Pigs with Allergic Rhinitis

One of the causes of nasal obstruction associated with allergic rhinitis probably is caused by the dilatation of plexus cavernosum in nasal mucosa. In this study, the change in vascular responsiveness of nasal mucosa was investigated in the septal mucosae isolated from guinea pigs with allergic rhinitis. An allergic rhinitis model was prepared in guinea pigs by repeated challenge with aerosolized dinitrophenylated-ovalbumin antigen. Twenty-four hours after the last antigen challenge, the changes in the isometrical tension of isolated nasal septal mucosa were measured. In isolated nasal mucosal tissues, both norepinephrine (NE) and leukotriene D4 caused concentration-dependent contractile and relaxant responses, respectively. The NE-induced contractile response was significantly attenuated in nasal mucosae of the repeatedly antigen challenged guinea pigs. The mucosal relaxation induced by leukotriene D4 was slightly attenuated in this animal model of allergic rhinitis. This study shows an attenuation of NE-induced contraction of isolated nasal mucosa in the antigen-exposed guinea pigs. The impaired contractile response mediated by sympathetic alpha-adrenoceptors of nasal blood vessels might be involved in the development of nasal obstruction in allergic rhinitis.

Humming-induced release of nasal nitric oxide for assessment of sinus obstruction in allergic rhinitis: pilot study.

Humming greatly increases nasal nitric oxide (NO) in healthy people by causing a rapid washout of NO from the sinuses. This increase is abolished in patients with complete sinus ostial obstruction. Allergic rhinitis is a risk factor for development of sinusitis and we wanted to study whether nasal NO measurement during humming could be used to detect sinus abnormalities in this disorder. Fifty-nine consecutive subjects with mild to moderate allergic rhinitis were studied. Their present nasal symptoms were recorded. Then NO levels were measured by chemiluminescence during quiet single-breath nasal exhalations and humming exhalations at a fixed exhalation flow of 0.2 L s(-1). Based on the NO results the patients were divided into two groups: those with a great increase in nasal NO during humming (humming responders, n = 46) and those without a significant increase (humming nonresponders, n = 13). In 11 of the nonresponders and in 22 of the responders the passage to the osteomeatal complex area was assessed and scored by nasal endoscopy. This was carried out by an oto-rhino-laryngologist unaware of the NO results. Among the nonresponders nine of 11 patients (80%) had endoscopic signs of bilateral sinus obstruction, compared with one of the 22 (< 5%) humming responders. Baseline nasal symptom score and NO levels during quiet exhalation were not significantly different between the groups Absence of a nasal NO peak during humming is associated with endoscopic findings suggestive of sinus ostial obstruction in subjects with allergic rhinitis. Measurement of nasal NO during humming may be a simple method to detect sinus abnormalities in these patients.

Obstructive sleep apnea in children: do intranasal corticosteroids help?

Obstructive sleep apnea (OSA) is a common condition of childhood, and is associated with significant morbidity. Prevalence of the condition peaks during early childhood, due in part to adenoidal and tonsillar enlargement within a small pharyngeal space. The lymphoid tissues regress after 10 years of age, in the context of ongoing bony growth, and there is an associated fall in the prevalence of OSA. Obstruction of the nasopharynx by adenoidal enlargement promotes pharyngeal airway collapse during sleep, and the presence of large tonsils contributes to airway obstruction. Administration of systemic corticosteroids leads to a reduction in the size of lymphoid tissues due to anti-inflammatory and lympholytic effects. However, a short course of systemic prednisone has been demonstrated not to have a significant effect on adenoidal size or the severity of OSA, and adverse effects preclude the long-term use of this therapy. Intranasal corticosteroids are effective in relieving nasal obstruction in allergic rhinitis, and allergic sensitization is more prevalent among children who snore than among those who do not snore. Intranasal corticosteroids have also been demonstrated to reduce adenoidal size, independent of the individual's atopic status. There is preliminary evidence of an improvement in the severity of OSA in children treated with intranasal corticosteroids, but further studies are needed before such therapy can be routinely recommended. Prescribing clinicians should take into account the potential benefits to the patient, the age of the child, the presence of comorbidities such as allergic rhinitis, the agent used, and the dose and duration of treatment when considering such therapy.

Effects of levocabastine on lipid mediator release from guinea pig lung fragments.

The effects of levocabastine, a novel histamine H1-receptor antagonist, on lipid mediator release induced by antigen-antibody reaction from actively sensitized guinea pig lung fragments were studied. Levocabastine dose-dependently inhibited the release of leukotriene C4 from guinea pig lung fragments induced by antigen. A significant effect was observed with levocabastine at a concentration of 10(-4) M. On the other hand, levocabastine produced no effect on the release of leukotriene E4 or thromoboxane B2. From these findings, it was concluded that levocabastine may be useful for relieving the nasal obstruction in allergic rhinitis caused by inhibition of leukotriene C4 release.

アレルギー性鼻炎の鼻閉に対するフマル酸エメダスチンの有効性

The effect of emedastine difumarate on nasal obstruction was examined in 21 patients (8 males and 13 females, average age: 26.3 years) with perennial nasal allergy. The patients received 2 mg of emedastine difumarate twice a day for one or two weeks. Objective measurement of nasal obstruction was performed by active anterior rhinomanometry using nozzle before and after treatment. Nasal resistance at the point of ΔP100Pa in inspiration was calculated for the analysis. For the statistical analysis the paired t test was applied.The decrease in the subjective symptom score was significant. However, there was a small but ot statistically significant decrease [0.416 Pa/(ml/sec)→0.360 Pa/(ml/sec)] in nasal resistance inn all cases. A significant decrease [0.500 Pa/(ml/sec)→0.307 Pa/(ml/sec), p < 0.05] in nasal resistance was noted in patients who had complained of slight nasal obstruction.Our findings confirm the efficacy of emedastine difumarOate in the treatment of nasal obstruction in allergic rhinitis.

Exercise-Induced Nasal Obstruction in Allergic Rhinitis

Exercise-Induced Nasal Obstruction in Allergic Rhinitis