Presence Of Allergic Rhinitis Research Articles

Objective and Subjective Outcomes Following Radiofrequency of Inferior Turbinates in Patients with Sleep-Disordered Breathing.

Nasal obstruction is a frequent problem amongst patients with sleep-disordered breathing (SDB). Radiofrequency of the inferior turbinates (RFIT) is commonly utilized for inferior turbinate (IT) reduction but its effectiveness in SDB patients remains unproven. We aim to evaluate long-term objective and subjective nasal, olfactory and sleep outcomes following RFIT in SDB patients. Patients were assessed at baseline (T0) and at 3 months (T1), 6 months (T2) and 12 months (T3) following RFIT. At T0, T1, T2 and T3, the patients underwent objective assessments of their nasal airways and smell function and an evaluation of their quality-of-life, sinonasal, olfactory and sleep symptoms. Sleep studies were carried out at T0 and T2. Seventeen patients (with a median age of 42 years) underwent RFIT. A statistically significant objective and subjective improvement of the patients' nasal airways was demonstrated at T1. No other statistically significant changes were observed in the patients' nasal airways, smell, sleep study parameters or patient-reported outcomes at the other follow-ups. A multivariate analysis confirmed a statistically significant influence of age (older), sex (male), a higher BMI, the presence of septal deviation and the presence of allergic rhinitis in some of the studies' parameters. A statistically significant objective and subjective improvement of the patients' nasal airways was confirmed in the fitted model when considering the influence of the available variables. Our study confirms that the benefits of RFIT alone in SDB patients are limited and possibly only in the short-term period. Patient-related variables can potentially influence the final outcomes.

Senzibilizacija na inhalacijske alergene kod djece s alergijskim rinitisom

Introduction: Allergic rhinitis is an inflammatory disease of the nasal mucosa that most often occurs in children and it is a growing global health problem. Aim: Aim of the study was to examine the sensitization on inhalant allergens in children with allergic rhinitis and its association with asthma. Methods: We performed a cross-sectional study using data from our hospital records (2018-2022). A total of 412 children with symptoms of allergic rhinitis participated in the study, aged from 4 to 17 years old. The presence of allergic rhinitis was evaluated by specialist of allergology, immunology and otorhinolaryngology. The diagnosis was made on personal and family history, physical examination of the patient, skin prick tests and laboratory parameters. Results: Out of 412 children enrolled in the study, 205 (55.1%) were male. All were diagnosed with allergic rhinitis, while 168 (40.78%) were, in addition to allergic rhinitis, diagnosed with bronchial asthma 66.26% (N=273). Hypersensitivity to the inhalant allergens according to positive skin prick test was found as follows: Dermatophagoides pteronyssinus (67.96%; N=280 subjects), Ambrosia artemisiifolia (62.87%; N=259 subjects), Betula (54.13%; N=223 subjects) Corylus (52.91%; N=218) and grass pollen (52.91%; N=218 subjects).Hypersensitivity to the inhalant allergens according to higher levels of specific IgE was found as follows: Dermatophagoides pteronyssinus (66.26%; N=273), Ambrosia artemisiifolia (66.02%; N=272), Betula (57.52%; N=237), Corylus (55.34%; N=228), Poa pratensis (45.39%; N=187), Artemisia vulgaris (27.67%; N=114), Phelum pratense (25.46%; N=105), cat dander (28.64%; N=118) and dog dander (23.54%; N=87). Conclusion: Our data suggest that sensitization on house dust mite has important role in development of allergic rhinitis. Most children have allergic rhinitis linked to asthma.

Quality-of-Life Assessment in Singaporean Children with Alopecia Areata

Introduction: Alopecia areata (AA) is an autoimmune dermatological disorder characterized by nonscarring hair loss. Its chronic and visible nature can negatively impact the quality of life (QoL) of patients with the condition. There has been a lack of studies on the QoL of pediatric patients with AA, especially from Asian countries. Objectives: This study aims to evaluate the impact of AA on the QoL of pediatric patients in Singapore. Methods: Between 2016 and 2017, 25 patients with AA were recruited to complete three questionnaires: Children’s Dermatology Life Quality Index (CDLQI), Family Dermatology Life Quality Index (FDLQI), and Pediatric Alopecia Areata Quality of Life Index. The results of these questionnaires were subsequently analyzed. Results: All three questionnaires had a broad range of responses, but scores were generally low, suggesting AA does not have a large impact on the QoL of our participants and their families. Two factors were identified to have resulted in better outcomes: the presence of comorbidity (atopic dermatitis, nail disease, food allergy, and allergic rhinitis) on the CDLQI and the presence of allergic rhinitis on the FDLQI. On the other hand, a later age of onset resulted in higher FDLQI scores. Conclusions: Similar to findings of other studies, the QoL of pediatric patients with AA is generally good, and clinical severity does not equate to worse QoL. Further studies are useful to provide more holistic care for the patient and their caregivers, involving both medical and psychosocial interventions.

Associations between long-term exposure to PM2.5 chemical constituents and allergic diseases: evidence from a large cohort study in China

BackgroundExposure to air pollutants may cause immune responses and further allergic diseases, but existing studies have mostly, if not all, focused on effects of short-term exposure to PM2.5 on allergic diseases. ObjectivesWe estimated associations of long-term exposure to PM2.5 chemical constituents with allergic disease risks and effect modification. MethodsWe used the baseline of a newly established, provincially representative cohort of 51,480 participants in southwest China. The presence of allergic rhinitis, allergic asthma, urticaria, and allergic conjunctivitis was self-reported by following a formed questionnaire in face-to-face interviews. The average concentrations of PM2.5 chemical constituents (NO3−, SO42−, NH4+, organic matter [OM], and black carbon [BC]) over participants' residence were estimated using machine learning models. Logistic regression with double robust estimator and weighted quantile sum regression were used to estimate the effects of PM2.5 chemical constituents on allergic disease risks, as well as relative importance of each PM2.5 chemical constituent. ResultsPer interquartile range increase in the concentration of all PM2.5 chemical constituents was associated with the elevated risks for allergic asthma (OR = 1.79 [1.41–2.26]), allergic conjunctivitis (1.54 [1.19–2.00]), urticaria (1.36 [1.25–1.48]), and allergic rhinitis (1.18 [1.11–1.26]). NO3− contributed more to risks for allergic asthma (weight = 46.05 %), urticaria (72.29 %), and allergic conjunctivitis (47.65 %), while NH4+ contributed more to allergic rhinitis (78.07 %). OM contributed most to the risks for allergic asthma (30.81 %) and allergic conjunctivitis (31.40 %). BC was also associated with allergic rhinitis, urticaria, and allergic conjunctivitis, only with a considerable weight for urticaria (24.59 %). Joint effects of PM2.5 chemical constituents on risks for allergic rhinitis and urticaria were stronger in minorities and farmers than their counterparts. ConclusionLong-term exposure to PM2.5 chemical constituents was associated with the increased allergic disease risks, with NO3− and NH4+ accounting for the largest variance of the associations. Our findings would serve as scientific evidence for developing more explicit strategies of air pollution control.

Frequency and Risk Factors of Difficult-to-Control Asthma among Patients

Abstract Background Difficult-to-control asthma (DTA) is associated with significant medical and financial burden. Difficult-to-treat asthma is asthma that is uncontrolled despite Global Initiative for Asthma (GINA) Step 4 or 5 treatment (e.g. medium or high dose inhaled corticosteroids (ICS) with a second controller; maintenance OCS), or that requires such treatment to maintain good symptom control and reduce the risk of exacerbations Objectives to assess causes and possible precipitating factors for difficult-tocontrol asthma in Kafr Elsheikh Chest Hospital. Patients and Methods This prospective cohort study enrolled 40 adult with DTA who were followed for 12 weeks. At the start, patients who had scores suggestive of DTA by using asthma control test (ACT) and questionnaire(ACQ) were enrolled. Spirometry was done at the start and adherence was ensured then spirometry was done again to eliminate possibility of non-adherence as a cause of uncontrolled asthma. ACQ and ACT were reassessed to classify patients. Result Male: female ratio was 1:1. Age ranged from 18.0 to 74.0 years. After twelve weeks, difficult-to-control asthma still present in 27.5%. There is statistically significant relation between DTA and all of family history of asthma, gastroesophageal reflux (GERD), allergic rhinitis/sinusitis, duration of asthma. On multivariate analysis, GERD, positive family history, comorbid allergic rhinitis, associated allergies and disease duration≥10 years increase risk of DTA by 4.56, 12.94, 1.389, 13.74 and 14.733 folds respectively. Conclusion GERD, positive family history, presence of allergic rhinitis, associated allergies and disease duration≥10 years were independent risk factors for DTA.

OTITIS MEDIA WITH EFFUSION AND ITS ASSOCIATED FACTORS AMONG PATIENTS WITH CEREBRAL PALSY: A MULTI-CENTER STUDY

Children with cerebral palsy (CP) are more prone to Otitis media with effusion (OME). We set out to determine the prevalence and factors associated with OME among patients with CPaged 2 to 18 years of age at two tertiary hospitals. Across-sectional study design was used. Diagnosis of OME was made on presence of a type B tympanogram. Of the 151 patients with CPrecruited the median age was 3 years (IQR 2.5-6.9). Majority were males (64.2%), had non-ambulatory CP (78.8%) and had breastfed for over 6 months (74.8%). Allergic rhinitis and nasal regurgitation of feeds were reported in 40.4% and 69.5% respectively. The prevalence of OME was 43.7%. Children who were breastfed for over 6 months (p value = 0.025) were less likely to have OME while presence of allergic rhinitis (p value = 0.016) and nasal regurgitation of feeds (p value = 0.035) increased the odds of presence of OME. The prevalence of OME among patients with CP is high (43.7%). Children with CP should breastfeed for more than 6 months to protect them against OME while timely management of nasal regurgitation of feeds and allergic rhinitis may minimize the risk of OME in these patients

Immunoglobulin Ige Levels And Clinical Dynamics Of Asthma In Children And Adolescents.

The involvement of IgE in type 1 hypersensitivity reactions, including asthma and allergic rhinitis, is widely recognized, and established. However, within this region, there exists a dearth of research exploring the relationship between serum IgE levels and the severity of asthma within the pediatric population. Consequently, the primary objective of this study was to compare the IgE status among children and adolescents diagnosed with asthma, and to examine its association with asthma exacerbations and hospitalizations. By investigating these parameters, we aimed to shed light on the potential role of IgE in influencing disease outcomes in this specific population. A retrospective study was conducted at The Aga Khan University Hospital from January 2015 to December 2020. Children and adolescents aged 6-18 years who were diagnosed and admitted with asthma, and who had measurement of IgE levels during asthma exacerbation were included in the study. The participants were stratified into two groups based on their IgE levels: normal IgE levels and high IgE levels. Various parameters, including the number of asthma exacerbations, emergency room (ER) visits, hospitalizations, average length of stay, as well as other clinical characteristics such as the presence of allergic rhinitis in the past and a family history of asthma were assessed. A total of 122 patients were included in the study. Of them 57 patients (46.72%) were found to have high IgE levels, and 65 patients (53.28%) had normal IgE levels based on their age group. The average number of exacerbations per year was significantly greater the in high IgE group (3.6±1.09), in comparison to the normal IgE group (2.49±1.22). Higher serum IgE levels correlated with increased asthma exacerbations, emergency room visits, hospitalizations, and a positive family history of asthma, suggesting a potential link between IgE and asthma severity in the pediatric population of Pakistan.

Bronchial Asthma Exacerbation in the Emergency Department in a Saudi Pediatric Population: An Insight From a Tertiary Hospital in Riyadh, Saudi Arabia.

Background Severe uncontrolled asthma in the pediatric population is a complicated disease and is considered a major challenge for pediatricians. Severe bronchial asthma in the pediatric population is related to significant morbidity and mortality. Children with complicated asthma are at a higher risk for unfavorable outcomes, including medication-associated adverse effects, severe life-threatening exacerbations, and poor quality of life. Methodology A cohort study was conducted at National Guard Health Affairs Hospital in Riyadh, Saudi Arabia. Data were collected using the chart review method utilizing a data collection sheet. A total of 363 charts of children aged one month to 14 years who visited the emergency room (ER) due to asthma exacerbation at NGHA were reviewed, from January 2016 to May 2022, to extract the variables. Variables included demographic data, comorbidities, and asthma-related variables which included the number of asthma exacerbations, hospital admission, ER visit, medication use (non-steroidal anti-inflammatory drugs and steroids), and the presence of allergic rhinitis and eczema. Results A total of 363 patients were analyzed, with 229 (63.1%) males and 134 (36.9%) females. The mean age was 4.9 years (SD = 3.5 years). Overall, 8.5% of patients had congenital heart disease, 4.1% had gastroesophageal reflux disease, 2.2% had diabetes mellitus, 1.9% had obstructive sleep apnea, and 0.6% had hypertension. Most patients presented with a cough at 88.2% (n = 320), followed by shortness of breath at 59% (n = 214) and fever at 46% (n = 167). Male asthmatics visited ER more than females. Forty-four patients were admitted to the hospital. Inhaled steroids were associated with fewer emergency department visits and night symptoms. Most asthmatic patients presented in the winter and fall seasons. Conclusions Asthma is a common pediatric respiratory disease that could be a burden if not controlled well. Unfortunately, the frequency of hospital admissions and pediatric ER visits due to asthma exacerbation is increasing. Comorbidities such as obesity and gastroesophageal reflux disease play a significant role in asthma control.

Nerve growth factor causes epinephrine release dysfunction by regulating phenotype alterations and the function of adrenal medullary chromaffin cells in mice with allergic rhinitis.

The presence of allergic rhinitis (AR) is an increased risk factor for the occurrence of bronchial asthma (BA). Nerve growth factor (NGF), in addition to its key role in the development and differentiation of neurons, may also be an important inflammatory factor in AR and BA. However, the pathogenesis of the progression of AR to BA remains to be elucidated. The present study aimed to investigate the ability of NGF to mediate nasobronchial interactions and explore possible underlying molecular mechanisms. In the present study, an AR mouse model was established and histology of nasal mucosa tissue injury was determined. The level of phenylethanolamine N‑methyl transferase in adrenal medulla was determined by immunofluorescence. Primary adrenal medullary chromaffin cells (AMCCs) were isolated and cultured from the adrenal medulla of mice. The expression levels of synaptophysin (SYP), STAT1, JAK1, p38 and ERK in NGF‑treated and untreated AMCCs were detected by reverse‑transcription‑quantitative PCR and western blotting. The epinephrine (EPI) and norepinephrine (NE) concentrations were measured by ELISA. It was found that the expression of SYP in AMCCs was enhanced in the presence of NGF, whereas, the concentration of EPI decreased significantly under the same conditions. Furthermore, NGF mediated the phenotypic and functional changes of AMCCs, resulting in decreased EPI secretion via JAK1/STAT1, p38 and ERK signaling. In conclusion, these findings could provide novel evidence for the role of NGF in regulating neuroendocrine mechanisms.

Investigation of the relationship between anosmia in patients with COVID-19 and allergic rhinitis and eosinophil levels

Anosmia is a common symptom of COVID-19 infection. In our study, we aimed to investigate the relationship between allergic rhinitis and eosinophil levels in patients who developed anosmia after COVID-19 infection. Patients who had experienced COVID-19 infection and subsequently developed anosmia were included in the study group, while those who had experienced COVID-19 infection but did not develop anosmia were included in the control group. The patients' allergy histories and eosinophil levels were retrospectively analyzed. Our study revealed a significant difference in eosinophil levels between patients with and without anosmia (p<0.05). Additionally, among 55 patients with pre-existing allergic rhinitis, 43 (78.2%) had normal or high eosinophil levels. There was no significant relationship found between age, gender, the most common presenting symptom, hospitalization status, presence of allergic rhinitis and asthma before COVID-19 and increase in allergic symptoms after COVID-19 infection, in patients with and without anosmia.While we did not find a relationship between the presence of allergic rhinitis and the development of anosmia, our study did show that eosinopenia is more pronounced in patients with anosmia. Furthermore, it has been suggested that eosinopenia may not be a suitable marker for patients with allergic symptoms before COVID-19, as these patients may have normal or high eosinophil levels.

Pleiomorphism of the cytokine profile in nasal polyp tissue depending on the phenotype of chronic rhinosinusitis with nasal polyps

To compare inflammation response in patients with different phenotypes of CRSwNP according to level secretion of the key cytokines in nasal polyp tissue. 292 patients with CRSwNP were divided into four phenotypes: group 1 - CRSwNP without respiratory allergy (RA) and without BA; group 2a - CRSwNP+ AR with aBA; group 2b - CRSwNP+AR without aBA; group 3 - CRSwNP+nBA. Control group (n=36) included patients with hypertrophic rhinitis without atopy or BA. Using multiplex assay we defined the level of IL-1β, IL-4, IL-5, IL-6, IL-13, IFN-γ, TGF-β1, TGF-β2, TGF-β3 in nasal polyp tissue. The evaluation of cytokines levels in nasal polyps in different CRSwNP phenotypes showed a pleiotropy of different cytokine secretion depending on different comorbid pathology. In control group we estimated the lowest levels of all detected cytokines in comparison with other CRS groups. High levels of local proteins IL-5 and IL-13 and low levels of all isoform of TGF-β characterized CRSwNP without RA and BA. The combination of CRSwNP with AR showed high levels of proinflammatory cytokines IL-6 and IL-1β, and high levels of TGF-β1 and TGF-β2. The combination of CRSwNP with aBA estimated low levels of proinflammatory cytokines IL-1β, IFN-γ; in case of CRS+nBA we determined the highest levels of TGF-β1, TGF-β2 and TGF-β3 in nasal polyp tissue. Each CRSwNP phenotype is characterized by different mechanism of local inflammation. This underlies the necessity to diagnose BA and respiratory allergy among these patients. The evaluation of local cytokine profile in different CRSwNP phenotypes can help to determine the target anticytokine therapy for patients who has low efficacy of basic corticosteroid therapy.

Persistent Asthma at School Age: Associated Factors in Preschool Children with Asthma.

Most patients with childhood asthma present their first symptoms at preschool age. Identifying modifiable risks and protective factors at an early age may help develop asthma prevention and control strategies. This study aimed to identify factors at preschool age that are associated with persistent asthma at school age. This retrospective observational study included preschool children with asthma from 2015 to 2020 at a university hospital in Southern Thailand. In total, 189 eligible participants (70.9% boys; median age, 7.6 [6.7, 8.5] years) were included. Wheeze characteristics included early transient wheeze, persistent wheeze, and late-onset wheeze that accounted for 55%, 27.5%, and 19.5% of the patients, respectively. Approximately 20% of the participants had persistent asthma. Breastfeeding was a protective factor (odds ratio [OR] 0.4 [0.2, 0.9], p = 0.04). The modifiable risk factors were siblings living in the same household (OR 2.6 [1.1, 6.2], p = 0.02) and residence in an industrial area (OR 3.8 [1.4, 10.5], p = 0.009). Additionally, presence of allergic rhinitis was associated with an increased risk of persistent asthma at school age (OR 3.6 [1.6, 8.2], p = 0.002). Early therapeutic interventions targeting modifiable factors provide a window of opportunity to prevent persistent asthma at school age.

DENTAL STATUS OF PRESCHOOL CHILDREN WITH MOUTH BREATHING

There is an increase in the number of children who have complicated nose breathing and its oral type. Preschool children are of particular concern according to clinicians. These circumstances contribute to the occurrence of a cariogenic situation in the oral cavity, namely, a violation of the quantitative and qualitative composition of oral fluid, a decrease in its remineralizing ability, a deterioration of oral hygiene and an increase in the population of cariogenic microflora. The purpose of our study was to assess the dental status of preschool children with oral breathing to develop more effective methods of preventing caries of temporary teeth that can be applied chairside during the dental appointment.
 During the research two groups of examined children 3 to 6 years old were formed: Group I 89 people with oral breathing (35 with allergic rhinitis, 42 with adenoids hypertrophy, 12 with open bite); II group (control) – 76 somatically healthy children without signs of orthodontic pathology. The presence of oral breathing was determined using a functional breathing test. Dental status was assessed by caries indices, Fedorov-Volodkina hygiene index and oral fluid pH.
 Research results and their discussion. According to the results of the examination it was found that there was no significant difference in the prevalence and intensity of caries of deciduous teeth, oral hygiene and the pH of oral fluid in children with oral breathing depending on the presence of allergic rhinitis, adenoid hypertrophy and bite pathology (р≥0.05). Therefore, there is no need to consider each of the groups separately in further research.
 According to the obtained data we have a significant difference in the prevalence and intensity of caries of deciduous teeth between both research groups. According to the results of examinations the prevalence of caries in children with oral breathing is almost 2 times higher than in practically healthy children. The same situation is observed when determining the caries intensity parameters, both according to the index DEF (teeth) and DEF (surfaces).
 Having evaluated the results of hygiene index determination the same dependence was obtained, namely, significantly higher indicators are noted in children with oral breathing. According to the data it was found that the oral hygiene of children of the research group with caries was at the level of “poor”, without caries – “unsatisfactory”. The participants of the control group with caries corresponded to the lower margin of the “satisfactory” level and the subjects without caries corresponded to the upper limit of the “satisfactory” state of oral hygiene. Survayed with caries have significantly higher parameters than those without it in both groups (≤0.05).
 According to the results of the pH index determination of oral fluid in preschool children, the same significant dependency between the data was found, as in previous studies. A significant difference was also found between the pH values of the oral fluid depending on the presence tooth caries. The acidity of mixed saliva was always higher in children with dental caries than in children without it in both research groups. The highest values were more distinctive for children with oral breathing (р≤0.05).
 A lower oral hygiene level was found in children with oral breathing, which provokes a shift of the pH balance of the oral fluid to the acidic direction compared to practically healthy subjects. This situation is complicated by the presence of caries of deciduous teeth. The deterioration of the studied parameters with age is also noted, which allows us to assume the dependence of the oral hygiene condition, the pH index of mixed saliva with an increase in the occurrence of oral breathing and the duration of the adjunct pathology. The physical parameters of the oral fluid have a direct effect on the neutralization of acids and the improvement of the cleaning quality of hard tissues.
 Conclusion. Therefore, the obtained data can serve as a background for the prescription of the previously proposed complex of treatment and preventive measures in children with hypertrophy of adenoids [8] for persons with concomitant diseases characterized by oral breathing.
 The perspective of further research is the study of a more extended list of parameters of oral cavity homeostasis in children with oral breathing as well as the study of the influence of the treatment and prevention complex on these parameters.

Pediatric turbinoplasty: what is the impact of allergy on long-term outcomes?

<p class="abstract"><strong>Background:</strong> The use of inferior turbinoplasty (IT) in pediatric patients is controversial, especially in the presence of allergic rhinitis. The objective of this study was to assess the long-term results of radiofrequency inferior turbinoplasty in allergic versus non-allergic children.</p><p class="abstract"><strong>Methods:</strong> Children operated between 2017 and 2019 and whose intervention included radiofrequency IT were included. Multiple scores were collected in 2021 through a telephone call to parents. A comparison was made between allergic children (AC) and non-allergic children (NAC). </p><p class="abstract"><strong>Results:</strong> 41 children were included. Parents of AC reported a higher degree of dissatisfaction with surgery (AC: 0.8±1 verses NAC: 0.2±0.5, p=0.026). AC revealed a greater dependence on medication in order to control nasal obstruction (41% in AC vs 6% in NAC, p=0.010). The total Nasal Obstruction Symptom Evaluation (NOSE) score was higher in AC (mean AC 26±25 verses mean NAC 5±12, p=0.003). The sinus and nasal quality of life 5 SN-5 score was higher in AC (mean AC 2.5±1 vs NAC mean 1.4±0.8, p<0.001).AC had a lower score on the SN-5 quality of life scale (mean AC 6.6±2.4 vs NAC mean 8.3±1.8, p=0.014).</p><p class="abstract"><strong>Conclusions:</strong> Radiofrequency IT alone does not seem effective in the long-term resolution of nasal obstruction in AC.</p><p class="abstract"> </p>

Allergic Rhinitis and House Dust Mite Sensitization Determine Persistence of Asthma in Children

ObjectiveTo specify clinical and immunological parameters of the mechanisms, which may lead to development of persistent asthma, or regression of the disease symptoms.MethodsEighty children with childhood asthma, diagnosed in the past by using the modified Asthma Predicted Index (mAPI), were divided into two groups: remission group and persistent group. There were 3 study visits (baseline, at 6 mo, and at 12 mo). Clinical remission of asthma was defined as the absence of asthma symptoms for at least 12 mo without treatment. The patients could switch from one group to another during the 12 mo of follow-up. Clinical, inflammatory, and immunoregulatory predictors of asthma remission/persistence were analyzed.ResultsThe presence of mAPI criteria as well as house dust mite (HDM) allergy and allergic rhinitis at 7–10 y, were associated with a reduced prevalence of asthma remission. The increased eosinophil blood count in mAPI criteria was associated with a lower expression of CD25 positive cells. HDM allergy was associated with a higher fractional exhaled nitric oxide (FeNO) level (p = 0.0061) and higher expression of CD25CD71 (p = 0.0232). Allergic rhinitis was associated with a higher expression of PPAR (p = 0.0493) and CD25CD71 (p = 0.0198), and lower expression of glycoprotein A repetitions predominant (GARP).ConclusionsPersistence of childhood asthma was largely determined by the presence of allergic rhinitis and sensitization to HDM. Additionally, API criteria but not immunoregulation processes, were related to asthma persistence.

Tomographic dimensions of the nasal vestibular body in relation to nasal obstruction in adults

Abstract INTRODUCTION. The nasal vestibular body is a recently reported dynamic elevation in the vicinity of the inferolateral internal nasal valve. The contribution of this anatomical zone in persistent nasal obstruction is not yet defined. OBJECTIVE. To assess the correlation between the tomographic size of the nasal vestibular body and the presence of nasal obstruction in adults. MATERIAL AND METHODS. An observational, analytical, prospective, cross-sectional study of a series of cases was conducted between August 1 and December 30, 2020. We included 23 adult patients and we recorded the sex, age, symptoms of obstruction, presence of allergic rhinitis, whether they used treatment for rhinitis, presence of septal deviation and dimensions in length and width of the nasal vestibular body. Patients were distributed in groups, with and without nasal obstruction, and the area of the vestibular body was measured in digital format using millimetre computed tomography. RESULTS. Of a total of 23 cases, 10 were men (43.48%) and 13 women (56.52%), mean age 28.8±10.2 years. 16 patients (69.57%) had symptoms of nasal obstruction and 7 (30.43%) were without obstruction. 10 patients (43.48%) presented symptoms of rhinitis. Using Spearman’s correlation test, we found a positive correlation between width (R = 0.79, p <0.001) and nasal vestibular body length (R = 0.77, p <0.001) and nasal obstruction. CONCLUSION. The nasal vestibular body is a structure that could be related to the symptoms of nasal obstruction in the adult population.

Predictors of bronchial asthma development in preschool children with recurrent broncho-obstructive syndrome

Objective. To study predictors of bronchial asthma development in children of 3-4 years old with recurrent broncho-obstructive syndrome by 5-6 years of age.Material and methods. The authors conducted a prospective cohort study in 2018-2020 with the participation of 61 children aged 3–4 years with recurrent broncho-obstructive syndrome. Inclusion criteria: age 3–4 years; ≥ 3 episodes of broncho-obstructive syndrome in the past 12 months; informed voluntary consent. At the first visit the scientists determined the levels of serum periostin, specific inhalation allergens IgE, total IgE and the number of eosinophils in the blood. In 24 months, at the second visit, bronchial asthma was diagnosed based on the GINA criteria (updated 2019). Binary logistic regression analysis was used to study the predictors of bronchial asthma development.Results. In 24 months from the beginning of the study, bronchial asthma was diagnosed in 29 (47%) children with recurrent broncho-obstructive syndrome. The level of serum periostin and total IgE had no effect on the risk of developing bronchial asthma (p=0,194; p=0,269). According to binary logistic regression, the predictors of bronchial asthma development are burdened family allergic history (odds ratio – OR 3,81; 95% confidence interval – CI 1,14-12,74; p=0,015), allergic rhinitis (OR 4,94; 95% CI 1,37–7,80; p=0,0001), sensitization to the Dermatophagoides pteronyssinus (OR 1,80; 95% CI 1,36–1,13; p=0,045) and eosinophilia (OR 2,10 ; 95% CI 1,23-4,83; p=0,055).Conclusion. A burdened family allergic history, the presence of allergic rhinitis, sensitization to the Dermatophagoides pteronyssinus, eosinophilia are the predictors of bronchial asthma development in children with recurrent broncho-obstructive syndrome by 5-6 years of age.

The prognostic variables affecting the frontal sinusotomy patency outcome and how to manage: A prospective study.

The study aimed to assess the factors affecting the frontal sinus patency after endoscopic frontal sinusotomy. A prospective cohort study. Tertiary centre hospital. Fifty patients with refractory chronic frontal sinusitis (83 operated frontal sinuses) had frontal sinusotomy and followed up for six months. Multiple operative factors were included the type of the procedure, intraoperative sinus findings, degree of mucosal preservation and middle turbinate stability. Other factors were also assessed, including smoking, the presence of allergic rhinitis, asthma, gastroesophageal reflux and other associated medical comorbidities. The sinus patency success rate was 75.9%. There was a significant difference regarding the intraoperative anteroposterior sinus ostium diameter (5.36±1.45mm vs 8.88±2.38mm, P-value: .001* in the failed group and the success group, respectively). There was a significant association between the patency outcome and the presence of associated medical comorbidities (P-value: .001*), the presence of allergic rhinitis (P-value: .001*), the degree of sinus mucosal preservation (P-value: .012*) and the degree of middle turbinate stability (P-value: .001*). The multivariate analysis showed that the intraoperative anteroposterior diameter of the sinus ostium, middle turbinate stability and presence of allergic rhinitis were significant predictors (P-value: .012*, .042* and .013*, respectively). Sinuses with anteroposterior ostium diameters less than 5.36mm are more susceptible to restenosis. The flail middle turbinate increases the risk of postoperative middle meatus synechia and frontal sinus patency failure. The presence of allergic rhinitis has a negative impact on the patency outcome.

Correlations Between the Adenotonsillar Microbiome and Clinical Characteristics of Pediatric Patients With Snoring.

ObjectivesFew studies have reported combined analyses of the microbiome of the adenoids and tonsils in pediatric patients with snoring, and correlations of the adenotonsillar microbiome with clinical characteristics have not been evaluated to date. The aim of this study was to characterize the adenotonsillar microbiome and to determine its correlations with the subjective symptoms of pediatric patients with snoring and with levels of regional mucosal immune molecules.MethodsTwenty-four children who underwent tonsillectomy with adenoidectomy owing to snoring were enrolled in this cross-sectional study conducted between August 2017 and December 2018. The microbiome of the adenoids and tonsils was characterized, and its alpha- and beta-diversity was determined. Clinical characteristics, including subjective discomfort during sleep (assessed using the obstructive sleep apnea-18 questionnaire), the presence of allergic rhinitis, concentrations of heat shock protein (Hsp)27, Hsp70, and interleukin-8 (IL-8) in lavage fluids, and white blood cell (WBC) counts, were measured.ResultsAt the phylum level, the microbiome was not significantly different between the adenoids and tonsils; the alpha and beta indices were likewise not significantly different between these two regions. The alpha-diversity of the entire adenotonsillar microbiome was associated with sex, emotional stress, and IL-8 levels in the tonsil lavage fluids. Beta-diversity was associated with Hsp27 levels in the tonsil lavage fluids and WBC counts. Multiple allergen simultaneous test results were not significant, although total serum immunoglobulin E levels were significantly associated with the beta-diversity of the adenotonsillar microbiome.ConclusionThe data reported herein suggest, for the first time, that the adenotonsillar microbiome interacts with the regional mucosal immune system. The observed association of the microbiome with subjective discomfort is a novel finding that warrants further investigation.

Serum vitamin D level is associated with smell dysfunction independently of aeroallergen sensitization, nasal obstruction, and the presence of allergic rhinitis in children.

Smell dysfunction is highly prevalent worldwide and has adverse effects on quality of life. Smell loss in rhinitis subjects is mainly caused by mechanical obstruction of odorant transmission due to mucosal type 2 inflammation. We determined the association of 25-hydroxyvitamin D (25[OH]D) levels with the severity of smell dysfunction in children. We measured the olfactory threshold score in a total of 518 children (10-12 years old, 264 boys) using the Sniffin' Sticks kit, and the children were divided into tertiles according to olfactory threshold score. We also assessed serum 25[OH]D level, common aeroallergen-specific immunoglobulin E, rhinitis severity with visual analog scale, and the Total Four Symptom Score, and pre- and post-decongestant nasal patency with acoustic rhinometry. The children with 25(OH)D deficiency had significantly reduced mean olfactory threshold scores when compared to those with 25(OH)D levels of ≥20.0 ng/mL (6.56 ± 3.54 and 7.28 ± 3.87, respectively, P = .036). The proportion of loss of smell function and pre-decongestant nasal patency significantly associated with low 25(OH)D levels (chi-square trend test, P for trend = .007). Likewise, after adjustment for confounders, children with smell loss (third tertile) were significantly associated with low 25(OH)D level (aβ=-0.062, 95% CI=-0.064 to -0.060, P = .009) independent of aeroallergen sensitization, and a low pre-decongestant nasal patency. 25-Hydroxyvitamin D is significantly associated with smell dysfunction independent of aeroallergen sensitization, nasal obstruction, and the presence of allergic rhinitis. This finding may provide insight into the mechanisms involved in the development of olfactory dysfunction.