Perennial Nasal Allergy Research Articles

Local Allergic Rhinitis in Adult Patients with Chronic Nasal Symptoms

Background: Local allergic rhinitis (LAR) remains an underdiagnosed condition characterized by the local production of IgE antibodies during the natural exposure to aeroallergens. The prevalence of LAR in adult patients with a previous diagnosis of non-AR was assessed. Material and Methods: Eighty-four patients with perennial nasal allergy symptoms but a negative skin prick test and specific IgE antibodies against common inhalant allergens were included in the study. Nasal provocation tests were performed with the inhalant allergens Dermatophagoides pteronyssinus, Alternaria, and cat allergen, followed by the detection of nasal-specific IgE antibodies in the lavage during the challenge. Results: LAR was confirmed in 21 (25%) study patients. In the remaining 63 (75%) patients, non-AR was diagnosed. In addition, LAR was found following exposure to D. pteronyssinus in 19 (22.6%) patients, Alternaria in 3 (3.6%) patients, and the cat allergen in 1 (1.2%) patient. In 2 patients, concomitant allergies to D. pteronyssinus and Alternaria were observed. Conclusion: LAR can be a form of chronic perennial rhinitis that has previously been considered to be non-AR.

A 24-month-follow-up study of argon plasma coagulation of the inferior turbinate in patients with perennial nasal allergy.

We report a 24-month-follow-up study of argon plasma coagulation of the inferior turbinate (APC) in patients with perennial nasal allergy. This was a retrospective study, in which 41 patients with perennial allergic rhinitis were treated by inferior turbinate reduction using APC. The grades of nasal stuffiness, rhinorrhea, sneezing and the daily activity impairment caused by these nasal symptoms were evaluated before and then 6, 9, 12, 15, 18, 21, and 24 months after APC, using a questionnaire graded on a four-point scale according to the Severity Criteria of Symptoms of Nasal Allergy issued by the Japanese Society of Allergology. Both nasal stuffiness and any daily activity impairment significantly improved 6 months after APC. Twenty four months after APC, 8/10 (80%) of the patients reported mild or no stuffiness and 9/10 (90%) of the patients reported mild or no daily activity impairement. Neither rhinorrhea nor sneezing were significantly improved during this study. Of the 41 patients 18 (43.9%) received no additional treatment. A second APC treatment was administered to 10/41 (24.4%) patients during follow-up period. Additional conservative medications were needed in 15/41 (36.6%) patients. Among the patients uncontrolled by conservative medical treatment, inferior turbinate reduction using APC provides significant relief in a 24-month-follow-up from nasal stuffiness and daily activity impairment.

Counteractive effect of Paeonia lactiflora root constituent mudanpioside E against suppressive effect of Shoseiryuto-extract on passive cutaneous anaphylaxis reaction in mice

Ethnopharmacological relevanceShoseiryuto-extract (SST) is a herbal formula of Japanese traditional kampo medicine used to treat perennial nasal allergy, rhinitis, and bronchial asthma. SST contains eight crude drugs, and is registered in the 16th Edition of Japanese Pharmacopoeia. Previous studies reported anti-allergic effects of SST, but the contribution of the eight crude drugs in SST on these effects has not been evaluated. In the present study, we evaluated the contribution of the eight crude drugs in SST on anti-allergic effect using passive cutaneous anaphylaxis (PCA) reaction in mice. Materials and methodsThe mixture of crude drugs was decocted in water and lyophilized to prepare SST. To evaluate the active ingredients, compositions of crude drugs were modified and decocted. The PCA reaction was induced by intravenous injection of ovalbumin (OVA) and Evans blue 48h after intracutaneous injection of anti-OVA serum in mice ears. The crude drug extract was orally administered to overnight-fasted mice 2h before induction of the PCA reaction. Ears were removed 30min after induction, and the amount of Evans blue present was measured. ResultsOral administration of SST suppressed the PCA reaction in a dose-dependent manner. Among the eight crude drugs comprising SST, Asiasarum root, Pinellia tuber, and Glycyrrhiza contributed positively, and Peony root contributed negatively to the anti-allergic effects of SST. We isolated mudanpioside E from the extract of Peony root as the counteracting ingredient to exhibit the anti-allergic effects of Peony root-depleted SST. ConclusionsWhen we used SST for the treatment of allergic diseases, removal of Peony root from the traditional formula could augment its effect.

S1-4 Clinical significance of Antihistamine for a management of seasonal and perennial nasal allergy(Antihistamine update (English Session))

S1-4 Clinical significance of Antihistamine for a management of seasonal and perennial nasal allergy(Antihistamine update (English Session))

アレルギー性鼻炎の経口薬治療の現状について‐富山県地方部会員のアンケート結果より考察する‐

Despite many antihistamine drugs available for use in nasal allergy treatment, no concrete drug selection guidelines exist. We report the results of a nasal allergy treatment questionnaire distributed to Toyama Prefecture otolaryngologists. Fexofenadine was most widely used in the early treatment of cedar pollinosis, but most otolaryngologists later changed drugs, especially second-generation antihistamines, based on patient condition and the type of perennial nasal allergy. Actual steroid treatment was thought to be proper and the various drugs were used in children’s medical treatment. Results were similar to those of past reports. We discuss concrete suggestions for selecting of second-generation antihistamine drugs based on these results.

Short-term effect of argon plasma coagulation of the inferior turbinate in patients with perennial nasal allergy

The aim of this study was to clarify the short-term effects of argon plasma coagulation (APC) of the inferior turbinate in patients with perennial nasal allergy. In a retrospective study, 32 patients with perennial allergic rhinitis were treated by inferior turbinate reduction using APC. Grades of nasal stuffiness, rhinorrhea, sneezing, nasal airflow resistance (NAR) and overall seriousness were evaluated before and then 1–4 and 8 weeks after APC. Subjective symptoms were assessed using a questionnaire in which nasal stuffiness, rhinorrhea and sneezing were graded on a four-point scale (severe, moderate, mild and none) using the Severity Criteria of Symptoms of Nasal Allergy issued by the Japanese Society of Allergology. NAR was measured using active anterior rhinomanometry (AAR) at the 100 Pa point; this was deemed to be an objective measurement of nasal obstruction. The numbers of patients examined before and 1–4 and 8 weeks after APC were 32, 31, 25, 17, 18 and 14, respectively. Both nasal stuffiness and NAR were significantly improved 2 weeks after APC, overall seriousness was significantly improved after 3 weeks and rhinorrhea was improved after 4 weeks. Sneezing did not significantly improve during this study. There was no significant change in the grades of the examined parameters during the period between 4 and 8 weeks after APC. The beneficial effects of APC begin to appear within 2 weeks after APC and no further improvement after about 4 weeks.

Long-term follow-up of argon plasma surgery for the perennial nasal allergy

Objectives: Argon plasma surgery is a new electrosurgical modality. The advantages of this surgery are coagulating of the target tissue without contact. We had reported the short-term effect of this surgery for perennial nasal allergy (Laryngoscope 111:147－152，2001). The purpose of this study was to evaluate the long-term effect of this surgery for perennial nasal allergy. Methods: In a prospective study, 241 patients (106 males, 135 females) with perennial nasal allergy were treated with this surgery. The surgery was performed with APC-300 and ICC-200 (Erbe Co, Tübingen, Germany). The surface of the inferior turbinate was coagulated. The patients’ nasal symptoms and objective evaluations of intranasal findings were assessed before surgery and at 1, 3, and 6 months and 1 and over 2 years after the surgery. Results: Nasal stuffiness was improved in 113 of 118 (95.8%) patients after 1 month, in 74 of 85 (87.1%) patients after 3 months, in 32 of 41 patients, in 25 of 35 patients after 1 year, and in 15 of 25 patients after 2 years. Rhinorrhea and sneezing were improved in about 60%. Congestion of the inferior turbinate was reduced in 114 of 118 (96.6%) patients after 1 month, in 81 of 85 (95.3%) patients after 3 months, in 34 of 41 patients after 6 months, in 22 of 35 patients after 1 year and in 16 of 25 patients after 2 years. Conclusion: Turbinate surgery with argon plasma coagulator for perennial nasal allergy showed excellent effects, especially on nasal stuffiness. The effects lasted relatively long-term.

Nasal airflow in children with maxillo-facial anomalies and nasal allergy

Both allergic nasal obturation and malformation of the hard palate, and thus the nasal cavities negatively influence nasal airflow. Allergic nasal obturation is recently more frequently diagnosed (16% of the population). As a research conducted by the Department of Orthodontics, Institute of Dentistry revealed, about 50% of children have some degree of malocclusion. The aim of this study was rhinomanometric evaluation of nasal obturation in children with malocclusion and perennial nasal allergy in various age groups, as well as assessing the influence of these pathologies on the clinical aspect of frequency of inflammations in the upper and lower respiratory tract, otitis and sinusitis. The study group comprised 40 subjects, aged 10–18, diagnosed with both nasal allergy and malocclusion. Three control groups comprised: 30 children with malocclusion (group II), 30—with perennial nasal allergy (group III) and 30—with neither of the pathologies (group IV). The data collected in the study indicated a similar degree of malocclusion for group I and II, in groups I and IV perennial nasal allergy. An increase in nasal resistances occurs in cases of nasal allergy (mean rhinomanometric values: 0.61±0.18 kPa/l/s for inspiration, 0.69±0.19 for expiration), as well as in cases of malocclusion with a resulting high-arched or gothic palate (0.52±0.18 and 0.58±0.21, respectively) in comparison with the healthy sample (0.32±0.11; 0.35±0.09 kPa/l/s). However, rhinomanometric assessment proved highest resistance values for group I—children with co-existing perennial nasal allergy and malocclusion: 0.81±0.29 and 0.89±0.41; in comparison with the control groups p<0.005. These children, as was established, have a higher liability to inflammations in the respiratory tract, otitis and sinusitis. They require an early multispecialist consultation (laryngologist, orthodontist) and treatment.

Study of Eosinophil Activation in Nasal Mucosa in Patients with Perennial Nasal Allergy: Effects of CO2 Laser Surgery

Carbon dioxide (CO2) laser surgery has been shown to be clinically effective in the treatment of nasal allergy. To investigate the mechanisms of eosinophil infiltration and activation underlying the therapeutic effects of CO2 laser surgery, we examined changes in the cytological profile of nasal mucosa after surgery. Twenty-two patients with perennial nasal allergy against house-dust mites underwent two or three rounds of laser surgery at 1-month intervals on an outpatient basis. The following parameters were evaluated at each visit: (i) improvement of clinical symptoms (nasal obstruction, rhinorrhea, and sneezing), (ii) percentage of infiltrating eosinophils in nasal mucosa, and (iii) the degree of EG2+ cells and intracellular adhesion molecule 1 (ICAM-1) expression by immunocytochemistry. All clinical symptoms significantly decreased after surgery. Significant reductions in eosinophil infiltration (p < 0.01) and the percentage of EG2+ cells (p < .005) were observed also. However, the degree of ICAM-1 expression in epithelial cells was not changed. These results suggest that CO2 laser surgery partially reduced the allergic reactions, leading to improvement of clinical symptoms.

Late phase responses after nasal challenges with allergen and histamine in asthmatic children with perennial nasal allergy

Objective: Late phase response (LPR) is difficult to investigate in patients with perennial nasal allergy because of their continuous presentation with nasal symptoms. Contribution of histamine to the LPR is also controversial. In this study, we investigated whether exogenous histamine can induce LPR in asthmatic patients with perennial nasal allergy to house dust. Methods: A total of 40 asthmatic children were divided into clinical, subclinical and non-rhinitis groups based on their daily nasal symptoms. Changes in nasal patency and in inflammatory cells in nasal secretion were quantitatively measured for 6 h by acoustic rhinometry and light microscopy respectively before and after nasal challenge with allergen or histamine. Results: The allergen challenge produced a significant biphasic decrease in nasal patency in the subclinical group and a marginal decrease in the clinical group, with increases in eosinophils 6 h after the challenge. By contrast, histamine challenge induced significant responses in the clinical group and only a slight response in the subclinical group. Eosinophils also accumulated in nasal secretion of the clinical group to significant levels 6 h after histamine challenge. Eosinophil accumulation following histamine challenge was earlier than that after exposure to allergen. Conclusion: We conclude that LPR can be demonstrated in asthmatic children with perennial nasal allergy. Exposure to exogenous histamine also induced LPR, mediated mainly by eosinophil-related mediators.

Association between nasal allergy and a coding variant of the Fc epsilon RI beta gene Glu237Gly in a Japanese population.

The gene for the beta-chain of the high-affinity receptor for IgE (Fc epsilon RI beta) has been proposed as a candidate gene for atopy. A coding variant Glu237Gly has been studied in various populations with asthma and atopy, and the results were controversial for association of the variant with atopy/asthma. Because nasal allergy is a more common atopic disease and shows less remission than asthma, we analyzed whether the Glu237Gly variant is correlated with nasal allergy. The study enrolled 233 patients with nasal allergy and 100 control subjects. Further, three subgroups were selected: patients with perennial nasal allergy (n=149), Japanese cedar pollinosis (n=189), and allergy to multiple allergens (n=45). The allele frequency of Gly237 in the controls and patients was 0.14 and 0.20, and the frequency of Gly237-positive subjects was 0.23 and 0.356, respectively. There was a significant association between Gly237-positivity and nasal allergy, perennial nasal allergy, Japanese cedar pollinosis, and allergy to multiple allergens. Among all 333 subjects we observed a significant relationship between Gly237 and elevated levels of serum total IgE (>250 IU/ml) and very high IgE (>1000 IU/ml). Among patients positive for a specific IgE, Gly237 was significantly associated with high IgE for house dust, mite, and Japanese cedar pollen. These results suggest that the Glu237Gly variant of the Fc epsilon RI beta gene is involved in the development of nasal allergy through the process for the production of both specific and nonspecific IgE antibodies.

Enhancement of submicroscopic damage of the nasal epithelium by topical allergen challenge in patients with perennial nasal allergy.

The purposes of this study were to clarify whether damage of the nasal epithelium exists in patients with nasal allergy, and how the morphology of the epithelium changes after topical allergen challenge. Electron microscopy revealed 2 characteristic features in the nasal epithelium of patients with perennial nasal allergy--an increase in the number of epithelial cells with cytoplasmic vacuoles, and markedly widened intercellular spaces--although these changes were unclear under light microscopy. The density of vacuolated cells significantly increased 24 hours after allergen challenge. Further, the number of eosinophils that were associated with vacuolated cells was significantly higher in patients with nasal allergy than in controls. These morphological changes, thus, were considered to be types of damage to the nasal epithelium associated with nasal allergy. Such changes may be among the causes of nasal hyperreactivity, which is an important feature of nasal allergy.

Argon plasma surgery for the inferior turbinate of patients with perennial nasal allergy.

Argon plasma coagulation (APC) is a new electrosurgical modality. The advantages of APC are coagulating of the target tissue without contact and the creation of uniformly deep devitalized and coagulated zones. The objectives of the present study were to determine the clinical effects of APC for the inferior turbinate of patients with nasal allergy and to clarify the histological changes in the mucosa after APC. In a prospective study, 95 patients with perennial nasal allergy were treated with APC. Nasal symptoms and intranasal findings were evaluated preoperatively and 1, 3, and 6 months, and 1 year after the APC. Mucosal specimens from the turbinates were examined under light and electron microscopy. Nasal stuffiness was improved in 77 of 79 (97.5%) patients after 1 month, in 50 of 51 (98.0%) patients after 3 months, in 20 of 23 (87.0%) patients after 6 months, and in 9 of 12 (75.0%) patients at 1 year after the APC. Rhinorrhea was improved in 46 of 75 (61.3%) patients after 1 month, in 40 of 51 (78.4%) patients after 3 months, in 16 of 21 (76.2%) patients after 6 months, and in 6 of 10 (60.0%) patients at 1 year after the APC. The sneezing was improved in 32 of 54 (59.3%) patients after 1 month, in 21 of 35 (60.0%) patients after 3 months, in 10 of 14 (71.4%) patients after 6 months, and in 6 of 8 (75.0%) patients at 1 year after the APC. In the intranasal findings, congestion of the inferior turbinate improved in 75 of 76 (98.7%) patients after 1 month, in 49 of 52 (94.2%) patients after 3 months, in 20 of 23 (87.0%) patients after 6 months, and in 7 of 11 (63.6%) patients at 1 year after the APC. The nasal discharge was reduced in 40 of 75 (53.3%) patients after 1 month, in 32 of 52 (61.5%) patients after 3 months, in 15 of 22 (68.2%) patients after 6 months, and in 5 of 11 (45.5%) patients at 1 year after the APC. No patients needed nasal packing after the APC. This is the first report on the clinical effects of turbinate surgery for nasal allergy using APC. APC was useful fer turbinate surgery of nasal allergy, especially for nasal stuffiness and congestion of the turbinate.

Role of vascular reflex in nasal mucosal swelling in nasal allergy.

In patients with nasal allergy, antigen challenge on the unilateral nasal mucosa results in nasal secretion not only in the ipsilateral but also in the contralateral nasal cavities that can be inhibited almost completely by premedication with atropine sulfate. The present study was performed to elucidate if centrally mediated vascular reflex induced by antigen challenge plays a role in nasal mucosal swelling in subjects with nasal allergy. Variations of mucosal swelling and mucosal blood flow in the ipsilateral and the contralateral nasal cavities after unilateral antigen challenge were evaluated by acoustic rhinometry and laser Doppler flowmetry in 20 patients with perennial nasal allergy. Unilateral antigen challenge caused ipsilateral and contralateral nasal mucosal swelling in 17 and 13 patients, respectively. Incidence of contralateral nasal mucosal swelling after unilateral antigen challenge was significantly higher compared with that after control disc challenge (P < .001). In 10 patients in whom unilateral antigen challenge caused bilateral nasal mucosal swelling, significant swelling of the nasal mucosa lasted for more than 30 minutes in the ipsilateral nasal cavity after antigen challenge compared with only 15 minutes in the contralateral nasal cavity. Peak values of contralateral mucosal swelling were 45.3% of those of ipsilateral nasal mucosa. Centrally mediated vascular reflex is partially involved in the onset of nasal mucosal swelling observed after antigen challenge in subjects with nasal allergy. However, nasal mucosal swelling that persists and proceeds even 20 minutes after antigen challenge is caused by the direct effects of chemical mediators on the nasal vasculature.

重度スギ花粉症の季節前内視鏡レーザー手術

Endoscopic CO2 laser surgery was performed before the onset of pollen scattering in 50 cases of severe Japanese cedar pollinosis, in which conservative treatment had no effect. Nineteen cases were pollinosis without perennial nasal allergy and 31 cases were pollinosis with perennial nasal allergy. A rigid endoscope and thin pipe guide were used in the surgical procedure. The inferior turbinate was prophylactically vaporized with a defocused carbon dioxide laser beam. During the first pollen season, 94% of the patients had excellent or good results without medication. No patients complained of severe nasal symptoms. During the second season after laser surgery, 79% of the patients had excellent or good results without medication. Two cases complained of severe nasal symptoms. The efficacy of laser surgery decreased somewhat during the second season. Prophylactic endoscopic laser surgery is a effective method of treatment for sever pollinosis.

Study on the long-term efficacy of emedastin difumarate in perennial nasal allergy

Study on the long-term efficacy of emedastin difumarate in perennial nasal allergy

Increased nitric oxide in nasal lavage fluid and nitrotyrosine formation in nasal mucosa--indices for severe perennial nasal allergy.

The nose contributes the large amount of nitric oxide (NO) to exhaled air. NO is a mediator of vasodilation and yields peroxynitrite (ONOO-) by reacting with superoxide (O2-). ONOO attacks tyrosine residues to form nitrotyrosine. The aim of this study was to examine the pathophysiological role of NO in nasal mucosa in patients with perennial nasal allergy. We measured nitrite and nitrate (NO2-/NO3-) and 3',5'-guanosine monophosphate (cyclic GMP) in nasal lavage fluid, and also measured haemoglobin concentration in nasal mucosa as an indicator of blood volume in the patients and healthy volunteers. The deleterious role of NO was also investigated by measuring nitrotyrosine in nasal mucosa. The NO2-/NO3- concentration in the nasal lavage fluid was 39.5+/-2.8 microM in healthy volunteers (n=40), 42.4+/-3.0 microM in patients with mild allergy (mild group, n=32), and 88.7+/-6.6 microM in patients with severe allergy (severe group, n=61). In the patients whose symptoms were improved with treatment, NO2-/NO3- levels decreased to 45.7+/-10.4 microM. The concentration of cyclic GMP in nasal lavage fluid was higher in the severe group than in the healthy volunteers. The mucosal haemoglobin index was 88+/-4 in the healthy volunteers, 67+/-4 in the mild group, and 53+/-2 in the severe group. The formation of nitrotyrosine was expressed 0.58+/-10% to total tyrosine in the severe group (n=11), but was not found in non-allergy patients (n=9). The production of NO was increased in patients with perennial nasal allergy, but the blood flow in the nasal mucosa of patients was reduced. Nitrotyrosine formation suggests that there is a process of ONOO(-)-induced damage in mucosa of patients with the perennial nasal allergy and this damage may limit the dilatation of blood vessels, despite the presence of excessive NO.

通年性鼻アレルギー患者を対象とした特異的IgE抗体測定法の検討

通年性鼻アレルギー患者を対象とした特異的IgE抗体測定法の検討

A study on the efficacy of emedastine difumarate in perennial nasal allergy

A study on the efficacy of emedastine difumarate in perennial nasal allergy

Time-course changes in nasal airway resistance after house dust antigen challenge: With special reference to late phase response

The definition of late-phase response (LPR) associated with nasal allergy is not as clear as that associated with asthma. Furthermore, LPR and immediate-phase response often act in concert to produce confounding symptoms due to repeated attacks over a short period of time. We examined the nasal airway resistance (NAR), allergic symptoms, eosinophil cationic protein and histamine concentration in nasal surface tissue 30 min before, and 10 min, 1, 3, 5, 7 and 9 h after a house dust (HD) nasal challenge test was performed twice on 10 patients with HD perennial nasal allergy. Nasal airway resistance readings after the HD nasal challenge test were classified into three types based on changes in NAR: type I (short-lasting, five cases); type II (prolonged, eight cases); and type III (biphasic, six cases). Delayed increases in NAR were not observed in type I patients with weak responses to nasal challenge. In type II patients, baseline NAR was elevated and numerous basophilic metachromatic cells (BC) were present in the epithelial layer. In type III patients, baseline NAR was not as elevated as it was in type II patients, but marked responses to challenge were noted. In all three types of changes in NAR, eosinophil leukocyte increased at late phase. Moreover, there was no correlation of change in NAR with an increase in the number of eosinophil leukocyte and BC at the epithelial layer in all three types, which suggests that further study is required to confirm the exact role of eosinophils and basophilic cells in LPR.