Allergic Rhinitis Research Articles

Efficacy of Biologic Therapies in the Management of Allergic Rhinitis: A Systematic Review

Efficacy of Biologic Therapies in the Management of Allergic Rhinitis: A Systematic Review

Exploration of Allergic Rhinitis: Epidemiology, Predisposing Factors, Clinical Manifestations, Laboratory Characteristics, and Emerging Pathogenic Mechanisms

Exploration of Allergic Rhinitis: Epidemiology, Predisposing Factors, Clinical Manifestations, Laboratory Characteristics, and Emerging Pathogenic Mechanisms

Features of the nasal microbiota in patients with allergic rhinitis: A review

The article analyzes the data of modern literature on the microbiota of ENT organs in normal and pathological conditions. The microbiota plays an important role in maintaining homeostasis by influencing metabolism, the immune system and human physiology. This complex of microorganisms includes bacteria, viruses and fungi that form the biofilm of otolaryngological organs, which prevents the penetration of pathogenic microorganisms. Different parts of the human upper respiratory tract have similar types of bacteria, but it differs dramatically at the level of families and genera. In addition, the balance of microbial flora depends on the immune system status, environmental factors, medication intake, age, race, lifestyle, as well as the health of other ENT organs. Changes in the nasal mucosa in allergic rhinitis are often associated with an increase in the content of bacteria. For example, Staphylococcus aureus can cause more severe nasal congestion in conjunction with protracted rhinitis and sinusitis. The production of bacterial proteinases contributes to easier penetration of allergens and activation of mucosal cells. The absence of microbiota can increase the response of the immune system and reduce the number of cells that contribute to the regulation of inflammation. This review presents an analysis of the composition of the normal microflora of otolaryngological organs and its effect on the occurrence of allergic rhinitis.

The protective effects and mechanisms of essential oil from Chimonanthus nitens Oliv. leaves in allergic rhinitis based on the NF-κB and T-bet/GATA-3 signaling pathways

Ethnopharmacological relevancePreliminary studies showed that Shanlameiye granules are derived from Chimonanthus nitens Oliv. Leaves ameliorate inflammatory responses in mice with Allergic Rhinitis (AR). The essential oil from Chimonanthus nitens Oliv. Leaves (CLO) have been identified as the key active substances in these granules. However, whether CLO constitutes the primary mechanism for the mitigation of AR-related inflammation by these granules has not yet been investigated. Aim of the studyThis experiment was to validate the effects and mechanism of CLO on inflammatory responses in RAW264.7 cells and AR rat model. Materials and methodsAn inflammatory model was induced in RAW264.7 cells by Lipopolysaccharide (LPS) & Interferon-gamma (IFN-γ) stimulation. AR rat model was established using both systemic and local challenges with Ovalbumin (OVA). ResultsIn cell experiments, CLO obviously decreased the secretion of cytokines and inhibited the NF-κB signaling pathway activation. In animal experiments, CLO decreased the number of eosinophils in the blood and lowered the levels of cytokines in nasal lavage fluid (NALF). Additionally, CLO inhibited the expression of STAT6, GATA-3, and p-p65, while increasing the expression of STAT4 and T-bet in the nasal mucosa. ConclusionIn AR rat model, CLO may play an anti-inflammatory role in AR rat model by regulating NF-κB and T-bet/GATA-3 signaling pathways.

Impact of asthma and allergic rhinitis control on sleep disordered breathing in pediatrics

AimThe aim of our study is to assess the quality of sleep in children with asthma and/or allergic rhinitis, as well as the impact of the control of allergic respiratory diseases on sleep disturbances. Materials and methodsIt is an observational cross-sectional study on children attending pediatric allergy appointments at a portuguese tertiary hospital (G1), and compared to a control population (G2). The asthma and rhinitis control was determined using the Control of Allergic Rhinitis and Asthma Test (CARAT/CARATKids) questionnaires. Sleep was evaluated using the Pediatric Sleep Questionnaire (PSQ). G1 included 61 patients and G2 included 100 children. ResultsAbout a third of the children in the study group had sleep-related breathing disorders (SDB), compared to 9 % on the control group (p-value <0.05). There was a significant positive correlation between uncontrolled asthma and allergic rhinitis, and SDB (p-value <0.05). ConclusionSDB is more prevalent among children with asthma and/or allergic rhinitis. The absence of control of the allergic respiratory diseases has a negative impact on sleep. We recommend large cross-sectional studies to better comprehend the exact relationship between the two conditions, as well as the use of objective diagnostic tools. We believe it is essential to implement early screening for sleep disorders in children with allergic respiratory diseases, through validated questionnaires.

Comparative study on health behaviors among adolescents with chronic allergic disease before and during COVID-19 using data from the Korean Youth Health Panel Surveys

BackgroundThis study aimed to investigate the changes in the health behaviors and subjective health perception of adolescents with chronic allergic disease, including atopic dermatitis, asthma, and allergic rhinitis, amidst the coronavirus disease 2019 (COVID-19) pandemic in South Korea.MethodsThis study used the 15th (2019) and 17th (2021) raw data obtained from the Korea Youth Risk Behavior Web-based Survey (KYRBWS), conducted by the Ministry of Health and Welfare of South Korea. Data were analyzed using multiple logistic regression with complex sampling using weighted values. Odds ratios with 95% confidence intervals for six health behaviors and subjective health perception were used as the major variables.ResultsSix health behaviors (dietary habits, weight gain, smoking, alcohol consumption, sleep time, and physical activity) changed substantially during COVID-19. There was an increase in the duration of sedentary activities, a slight increase in BMI, and improvements in mental health. Concurrently, there was a decrease in alcohol consumption, sleep duration, and the consumption of sweetened beverages. Despite these improvements in big six health behaviors, adolescents with chronic illnesses continue to perceive themselves as unhealthy.ConclusionsThese findings suggest that the follow-up and monitoring of health behaviors and subjective health perception in adolescents with chronic allergic diseases during the COVID-19 pandemic are necessary. Understanding the mechanisms underlying sustained behavioral change can inform the development of interventions to promote healthy behavior after the pandemic has passed.

Additive Effect of Blood and Tissue Eosinophilia on ChronicRhinosinusitis With Nasal Polyps.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a highly heterogeneous disease with varied clinical features and treatment effects. This study aimed to investigate the additive effect of blood and tissue eosinophilia on patients with CRSwNP. Based on the blood eosinophil (Beos) count and tissue eosinophil (Teos) count, we divided 144 CRSwNP patients into four groups, analysed their clinical features and histopathologic changes, and investigated their postoperative control. Patients in the Beos+Teos+ (blood eosinophil count > 0.3 × 109/L, tissue eosinophil count > 10/HPF) group had a higher incidence of allergic rhinitis (AR) and asthma. Lund-Mackay (LM) scores, hyposmia visual analogue scale (VAS) scores and Global Osteitis Scoring Scale (GOSS) scores were higher in the Beos+Teos+ group than those in the other groups. Tissue remodelling, such as connective tissue oedema and basement membrane thickening was more severe in the Beos+Teos+ group compared with other groups. There were more uncontrolled patients after surgery in Beos+Teos+, Beos+Teos- (blood eosinophil count > 0.3 × 109/L, tissue eosinophil count ≤ 10/HPF)and Beos-Teos+ (blood eosinophil count ≤ 0.3 × 109/L, tissue eosinophil count > 10/HPF)groups compared with the Beos-Teos- group. Eosinophilic inflammation both in blood and tissue was accompanied by more severe clinical features and tissue remodelling. Eosinophilia in blood or tissue indicated poorer disease control after surgery.

Efficacy and safety of warm needle acupuncture for allergic rhinitis: A systematic review and meta-analysis with trial sequential analysis

BackgroundsWarm needle acupuncture is a distinct form of acupuncture therapy in which, after the needle is inserted into the acupoint, a lit moxa stick is placed on the needle's handle. ObjectiveThis research aims to provide evidence for efficacy and safety of warm needle acupuncture for allergic rhinitis. Search strategiesSeven online databases were searched for study collection, which were published up to March 15th, 2022. Keywords of searching included “AR”, “allergic rhinitis”, “anaphylactic rhinitis”, “warming needle”, “warming needle acupuncture”, “needle warming moxibustion”, “warm needle”, “warm needling method” and “warmed needle”. The quality of the included trials was assessed using the Cochrane risk of bias tool. InterventionsAmong the included trials, warm needle acupuncture—either alone or in combination with Western medicine or other acupoint-based therapies—served as the primary intervention for the experimental groups. In contrast, the control groups received treatments such as Western medicine alone, manual acupuncture alone, or a combination of electro and manual acupuncture. Systematic reviews and meta-analyses were conducted using RevMan 5.3, following the Cochrane systematic review methodology, while trial sequential analysis was performed with TSA 0.9. The quality of the findings was assessed using GRADEpro. ResultsFinally, 23 studies involving 2230 participants were covered. Results of this study revealed that warm needle acupuncture only, or with western medicine, or with other acupoint-based interventions were significantly superior to western medicine alone, manual acupuncture alone, or electro plus manual acupuncture for allergic rhinitis. Adverse events associated with warm needle acupuncture included sensations of chest tightness, throat itching, and allergic reactions to moxa smoke; however, these occurrences were not more frequent than those observed with Western medicine. There is need for RCTs of high quality with placebo or waitlist controls of the intervention for allergic rhinitis. ConclusionWarm needle acupuncture is with potential efficacy and is safe for patients with allergic rhinitis, but more trials are need for further confirmation of the evidence.

Sensitization and allergy to pineapple and coconut juice in patients followed up for allergic diseases in Parakou, Benin

Objectives: Little is known about adverse food reactions. The aim of this study was to investigate the sensitization and allergy to two tropical fruits, pineapple (Ananas comosus) and coconut (Cocos nucifera), among patients followed up for allergic disease in Borgou Teaching Hospital in Parakou, Benin. Materials and Methods: A prospective cross-sectional study was conducted in 2021. Adult patients (≥18 years) who were followed up for allergic asthma, rhinitis, or conjunctivitis were included in the study. Information on clinical manifestations following pineapple juice or coconut water drinking was collected, and skin prick testing was carried out. Results: Overall, 101 patients were enrolled, male-female ratio of 0.4:1 and mean age of 33.4 (±14.4) years. Clinical manifestations were triggered by pineapple in 53.5%, mainly mouth and lip pruritus (38.6%). The prevalence of sensitization was 36.6%. Allergy was diagnosed in 24.8% (or 46.3% of those who complained) and was associated with mouth and lip pruritus (odds ratio [OR] = 4.1; 95% confidence interval [CI] = 1.6–10.6; P = 0.003), bronchospasm (OR = 3.7;95%CI = 1.1–12.7; P = 0.031), allergic rhinitis (OR = 3.5; 95%CI = 1.2–10.4; P = 0.020), and conjunctivitis (OR = 4.4; 95%CI = 1.6–12.5; P = 0.007). Clinical manifestations after ingestion of coconut water reportedly occurred in 18.8% and were mostly bronchospasm (8.9%). The prevalence of sensitization was 20.8%. Allergies were diagnosed in 6.9% (or 33.3% of those who complained), with no association found with demographic or clinical characteristics. Conclusion: Pineapple is a common cause of food allergy among patients who are followed up in Borgou Teaching Hospital, while coconut is less responsible for this disorder. More studies are required to improve knowledge of allergic diseases in Sub-Saharan Africa, which is facing an epidemiological transition.

An Experimental Mice Model for Ovalbumin‐Induced Allergic Rhinitis Imbued With Copper Oxide Green Nanoparticles From Leaf Extract of Laurus nobilis

ABSTRACTThis study aims to develop a safer and more effective treatment for allergic rhinitis using green‐synthesized copper oxide nanoparticles (CuO NPs) derived from Laurus nobilis (L. nobilis), addressing the limitations of current therapies. The environmentally friendly CuO NPs were evaluated for their antiallergic, anti‐inflammatory, and antimicrobial properties. Various analytical techniques confirmed the successful synthesis of CuO NPs. Phytoconstituents were identified using GC–MS, and molecular docking studies indicated that eugenol and 1H‐cyclopropazulen‐7‐ol, present in L. nobilis leaf extract, could be potential therapeutics targeting the FGFR2 protein. The antibacterial activity of CuO NPs was significant against Gram‐positive (Bacillus subtilis [B. subtilis] and Staphylococcus aureus [S. aureus]) and Gram‐negative (Escherichia coli [E. coli] and Klebsiella pneumoniae [K. pneumoniae]) bacterial strains. In a mouse model, the antiallergic effects were demonstrated by a significant reduction in symptoms like rubbing and sneezing and a decrease in inflammatory cell counts and mediators, including neutrophils, eosinophils, macrophages, lymphocytes, RORc, IL‐17A, IL‐5, IL‐13, and IL‐6. The preclinical results suggest that CuO NPs possess promising antibacterial, antiallergenic, and anti‐inflammatory properties.

Review of the development and latest perspectives in 2024 on Allergic Rhinitis and its Impact on Asthma (ARIA)

Review of the development and latest perspectives in 2024 on Allergic Rhinitis and its Impact on Asthma (ARIA)

Role of glucocorticoid receptor beta in the development of steroid resistance

Glucocorticoids (GCs) are the most commonly used anti-inflammatory drugs for the treatment of inflammatory diseases, despite the fact that the resistance to them is increasing due to various circumstances. GC insensitivity is an important clinical issue that is associated with life-threatening disease progression. Currently, there is no reliable biomarker that can be used to define steroid resistance. According to several studies, increased expression of the glucocorticoid receptor beta (GR-β) isoform is associated with steroid resistance. The purpose of this review is to analyse the correlation between GR-β expression and the occurrence of steroid therapy-resistant diseases and to determine its potential as a biomarker. This review summarizes studies that point out increased GR-β expression in steroid-resistant groups of patients compared to steroid-sensitive groups. Articles included in the review focus on asthma, nasal polyposis, ulcerative colitis, and other chronic inflammatory diseases in which resistance to steroid therapy is observed. GR-β levels have also been shown to be elevated in patients with allergic rhinitis, Crohn's disease and rheumatoid arthritis. In most studies, higher levels of GR-β were detected in peripheral blood mononuclear cells (PBMC) by reverse transcription polymerase chain reaction (RT-PCR). Increased expression of GR-β is mostly associated with steroid resistance. Thus, it can potentially be used as a biomarker of steroid resistance-related disorders.

A case study on the management of Prathishyaya (Chronic Allergic Rhinitis) using Bharangi Arka Nasal Spray

The omnipresence of Prathishyaya among school-aged groups is overlooked until the complications like kasa, swasa and rajayakshma come into being. Pratishyaya if taken heed of in the initial stage, helps to frustrate the looming effects of its complications. Bharangi Arka is cited as an effectual remedy for Prathishyaya in the Arka Prakasha of Ravana. Prescribing medications for children is usually challenging as they often resist taking them and so, Ayurveda formulations when transmuted into more palatable forms can have salutary impacts on children than classical forms. This case study was carried out on an 8 ½ years old male child with sneezing, runny nose and chronic symptoms including nasal itching and obstruction in particular. Prathishyaya was diagnosed after a proper clinical evaluation. Bharangi Arka in the form of nasal spray was opted as the sole drug in the treatment. Assessment of symptoms was done using Total Nasal Symptom score on the 7th, 14th, 21st and 28th days of the first month of the treatment and at the end of the following two months. Subsidence of all the symptoms was observed in the patient almost in the 4th week. This corroborates the stupendous action of Bharangi Arka nasal spray on Pratishyaya and it could usher in a way for further research to be carried out on the potency of nasal sprays in Ayurveda.

Roles of noncoding RNA in allergic rhinitis.

Allergic rhinitis (AR) is one of the most common respiratory noninfectious diseases and chronic inflammatory diseases, the incidence of which has been increasing in recent years. The main pathological characteristics of AR are repeated inflammation, airway hyperreactivity, mucus hypersecretion, and reversible airway obstruction due to inflammatory cell response. AR occurrence is associated with various factors, including those of genetic and environmental origins. Noncoding RNAs (ncRNAs) are a group of RNA molecules that cannot be converted into polypeptides. The three main categories of ncRNAs include microRNAs (miRNAs), long ncRNAs (lncRNAs), and circular RNAs (circRNAs). NcRNAs play a crucial role in controlling gene expression and contribute to the development of numerous human diseases. Articles are selected based on Pubmed's literature review and the author's personal knowledge. The largest and highest quality studies were included. The search selection is not standardized. Several recent studies have indicated the relationship of ncRNAs with the development of respiratory allergic diseases. NcRNAs, including miRNAs, lncRNAs, and circRNAs, are important gene expression regulatory factors. We review the expression and function of ncRNAs in AR, their role as disease biomarkers, and their prospective applicability in future research and clinically. We also discuss interactions between ncRNAs and their influence on AR comprehensively, these interactions are essential for determining the underlying pathological mechanisms further and discovering new drug therapeutic targets. NcRNAs can be used as biomarkers for early AR diagnosis, disease surveillance and prognosis assessment. Various categories of ncRNAs play distinct yet interconnected roles and actively contribute to intricate gene regulatory networks. They are also therapeutic targets and biomarkers in other allergic diseases. This article demonstrates ncRNAs have a wide range of applications in AR treatment. The database covers three key areas: miRNAs, lncRNAs, and circRNAs. Additionally, potential avenues for future research to facilitate the practical application of ncRNAs as therapeutic targets and biomarkers will be explore. With further research and technological development, ncRNAs may provide additional innovative, effective solutions for AR treatment.

Vitamin D Deficiency as a Contributing Factor to Chronic Rhinitis in Middle-Aged and Older Adults: An Epidemiological Study.

Recent studies suggest a critical role for vitamin D in respiratory diseases, including asthma and allergic rhinitis. However, the relationship between vitamin D deficiency and chronic rhinitis, particularly in middle- and older-aged populations, remains underexplored. This study aimed to investigate the association between vitamin D deficiency and chronic rhinitis in middle- and older-aged adults while controlling for lifestyle and physical status factors. Data from 12,654 participants aged 40 years and older were analyzed from the fifth Korean National Health and Nutrition Examination Survey (2010-2012). The prevalence of chronic rhinitis and its association with serum vitamin D levels were assessed using multiple logistic regression models, adjusting for demographic, lifestyle, and physical characteristics. The prevalence of chronic rhinitis was 21.1%. Participants with chronic rhinitis had a higher prevalence of vitamin D deficiency (69.9% vs. 65.2%) and lower mean vitamin D levels (17.73 ng/mL vs. 18.19 ng/mL) compared to those without chronic rhinitis. After adjusting for confounding factors, vitamin D deficiency remained significantly associated with an increased likelihood of chronic rhinitis (OR = 1.21, 95% CI, 1.082-1.348, p = 0.001). This study identifies a significant association between vitamin D deficiency and chronic rhinitis in middle- and older-aged adults, suggesting that maintaining adequate vitamin D levels may be important in managing chronic rhinitis.

6813 Des-Ciclesonide: A Novel Selective Glucocorticoid Receptor Modulator With Therapeutic Potential for Bronchopulmonary Dysplasia, a Chronic Lung Disease of Prematurity

Abstract Disclosure: N. El Khoury: None. J. Jaumotte: None. C. Min: None. C. Madigan: None. J. Wang: None. U. Chandran: None. V. Sampath: None. T.J. Cole: None. P. Monaghan-Nichols: None. R. Houtman: None. K.W. Nettles: None. D.B. DeFranco: None. Infants born before 30 weeks gestation are at risk of developing bronchopulmonary dysplasia (BPD), a prevalent chronic lung disease of prematurity. Glucocorticoids (GCs) such as dexamethasone (DEX) have been a mainstay of BPD prevention as they reduce lung inflammation and injury. However, their use is encumbered with several adverse effects including hyperglycemia, impaired somatic and brain growth and cerebral palsy. These major concerns have resulted in the AAP recommending caution in GC use in preterm infants.Ciclesonide (CIC), an inhaled GC prodrug approved for the treatment of asthma and allergic rhinitis in children, is converted to the potent glucocorticoid receptor (GR) agonist des-ciclesonide (DES) by enzymes enriched in the airways. We previously reported that s.c. delivery of CIC in neonatal rats activated GR transcriptional responses in lung but did not trigger the adverse effects on somatic growth, brain weight or cerebral white matter loss caused by DEX leading us to propose CIC as a potential new pharmacotherapy for BPD. To determine whether limited systemic metabolism of CIC in neonatal rats was solely responsible for its enhanced safety profile, we assessed various outcomes in neonatal rats followed s.c. delivery of its active metabolite DES. Consistent with previous studies, five daily s.c. injections of DEX led to a reduction in body and brain weight as well as reduced serum levels of insulin-like growth factor-1 and chronic hyperglycemia. Surprisingly, analogous s.c. injection of neonatal rats with DES, which has a higher binding affinity for GR than DEX, did not trigger any of these adverse effects. However, DES is as effective as DEX in reducing the expression of various proinflammatory cytokine mRNAs in neonatal rat lung induced by an 11-day systemic treatment with bleomycin. Bulk RNAseq analyses revealed transcriptional responses of neonatal lung and liver to DES, although less robust than that observed to DEX (i.e., 25% and 13% in lung and liver, respectively). Nonetheless, a NAPing assay for coregulator peptide binding showed increased binding of all the DES responsive peptide interactions relative to DEX and cortisol. All-atom molecular dynamics simulations revealed site-specific H-bonding changes within the GR ligand binding domain (LBD) caused by the bulky C16/C17substitution within DES, which was translated into broader changes in LBD structure, specifically revealed as differences in RMSF in helix 7/8 and the surfaces interacting with the NCOA2 peptide. Furthermore, network pathway analysis illustrated that DES mobility at helix 7/8 uniquely generated a meaningful allosteric signaling pathway between Q642 and NCOA2 peptide. In conclusion, the pharmacokinetic properties of the GR prodrug CIC coupled with the tissue-selective pharmacodynamic properties of its active metabolite DES make this FDA approved drug a potential new therapeutic agent for BPD. Presentation: 6/3/2024

Fecal zonulin as a prognostic marker of atopic march in children with food allergy

Introduction. The onset of allergic diseases most often occurs in early childhood with the onset of food allergies, which can subsequently lead to the implementation of the atopic march. Increased intestinal permeability with high production of zonulin, the main moderator of intestinal tight junctions, can be an important link in the development of comorbid allergic diseases.Material and methods. In order to study the significance of fecal zonulin as a marker for predicting the atopic march in children with food allergy, a cross-sectional retrospective study was conducted on 73 children aged 5 years who were diagnosed with food allergy (FA) to cow’s milk proteins in the first year of life. In all children, when the diagnosis was made in the first year of life, the content of zonulin in feces was determined using the ELISA method.Results. As a result of dynamic observation, all children with food allergy were divided into 2 groups: the first group consisted of children with food allergy who developed allergic rhinitis and/or bronchial asthma within 5 years (group I, n = 39), group 2 consisted of 34 children with food allergy who did not implement the atopic march within 5 years of observation (group II, n = 34). Our study showed statistically significant differences in the fecal zonulin level in the first year of life: group I Me = 2.39 ng/ml (Q1-Q3: 1.78–2.65 ng/ml), group II Me = 1.85 ng/ml (Q1-Q3: 0.49–0.91 ng/ml), p = 0.034. Strong direct correlations were found (Spearman correlation coefficient S = 0.681 (p &lt; 0.05)) between the zonulin level in feces at the onset of the disease and the development of allergic rhinitis and/or bronchial asthma up to 5 years of age, the data were confirmed by comparing the areas under the curves during ROC analysis, AUC in the study of fecal zonulin as a prognostic marker of the risk of atopic march in children is 0.887, the optimal threshold (cutoff point) is 1.94 ng/ml.Conclusions. Fecal zonulin level in children with food allergy can be an effective prognostic marker of atopic march development, its values in feces above 1.94 ng/ml allow us to predict with a high degree of probability the risk of atopic march development in children with food allergy to cow’s milk proteins within 5 years

8301 A Rare Case of IgG4-Related Hypophysitis

Abstract Disclosure: P. Kesavan Chary: None. J.M. Silverstein: None. Background: IgG4-related disease (IgG4-RD) is an immune-mediated condition that presents as systemic inflammation and fibrosis of tissues, often affecting multiple organs. Isolated IgG4-related Hypophysitis is rare and characterized by lymphoplasmacytic infiltration of the pituitary gland by IgG4-positive plasma cells. A combination of clinical, serologic, radiologic, and histopathologic findings is used for diagnosis of IgG4-RD and approximately two-thirds of all patients have elevated serum IgG4 levels. We report a case of isolated IgG4-related Hypophysitis in a middle-aged woman serologically negative for IgG4-related disease. Case Report: A 52 year old female with history of steroid dependent severe persistent asthma, allergic rhinitis, and chronic sinusitis presented with one month of headache, polyuria, and polydipsia. MRI Brain demonstrated an enlarged, rounded pituitary gland 16 x 11 x 9 mm, with homogeneous enhancement, extension into the suprasellar cistern, and mild thickening of the infundibulum suspected to represent a pituitary adenoma. Lab evaluation revealed mild hyperprolactinemia (prolactin 83.2, normal 4.8-23.3 ng/mL) and secondary adrenal insufficiency based on an abnormal high-dose cosyntropin stimulation test in the setting of a low adrenocorticotrophic hormone (ACTH) level (&amp;lt;2.0 pg/mL). Remaining pituitary hormone levels were normal. Inpatient work-up for polyuria and polydipsia showed a low urine specific gravity of 1.003. An overnight water deprivation test was performed. Baseline urine osmolality (UOsm) was 95 mOsm/kg and serum sodium was 144 mmol/L; after 3 hours of water deprivation, serum Osm increased to 301 mOsm/kg (275-300 mOsm/kg) and UOsm only to 215 mOsm/kg, while her sodium increased to 145 mmol/L. Results were felt to be consistent with AVP deficiency (Central Diabetes Insipidus) and the patient was started on desmopressin. Because of the presence of AVP deficiency, further work-up was done to evaluate for an infiltrative process or malignancy. ANA, RPR, ESR, CRP, CBC, ACE level, T-SPOT, and IgG subclasses were unremarkable. Further imaging studies yielded a negative nuclear bone scan and PET/CT scan. For diagnostic purposes, the patient underwent biopsy via an endoscopic endonasal transsphenoidal approach. Pathology showed the presence of &amp;gt;10 IgG4+ plasma cells in a single high-power field, consistent with a diagnosis of IgG4-related Hypophysitis. Conclusion: Isolated IgG4-related Hypophysitis is the least common clinical presentation of IgG4-RD, which is itself a rare and relatively newly recognized condition. IgG4-related Hypophysitis should be suspected in patients presenting with AVP deficiency and pituitary stalk enlargement with an otherwise negative work up. Presentation: 6/2/2024

Alternatives Methods for Treatment of Allergic Rhinitis, Alzheimer’s disease and Hypertension

Alternatives Methods for Treatment of Allergic Rhinitis, Alzheimer’s disease and Hypertension

Cysteinyl Leukotriene Receptor Antagonism by Montelukast to Treat Visual Deficits.

Montelukast, a Food and Drug Administration-approved drug for asthma and allergic rhinitis modulates leukotriene (LT) receptors and serves as a critical anti-inflammatory agent. Recent research suggests that the LT signaling pathway targeted by montelukast has broader implications for diseases such as fibrosis, cardiovascular diseases, cancer, cerebrovascular disease, and immune defense. This expanded understanding highlights montelukast's potential for repurposing in conditions involving aberrant stress mechanisms, including ocular diseases marked by inflammation, oxidative stress, ER stress, and apoptosis, among several others. This review delves into montelukast's therapeutic mechanisms across various diseases, draws parallels to ocular conditions, and examines clinical trials and associated adverse effects to underscore the unmet need for cysteinyl LT receptor antagonism by montelukast as an effective therapy for visual deficits.