Rhinitis Subjects Research Articles

Investigation of the diagnostic accuracy of basophil activation test for allergic phenotypes of rhinitis.

Basophil activation test (BAT) might be an alternative to nasal allergen challenge (NAC) to identify the allergic etiology in rhinitis patients. Here, we investigate the diagnostic performance of BAT for allergic phenotypes of rhinitis. Rhinitis patients and healthy controls were subjected to NAC with Dermatophagoides pteronyssinus (DP), Alternaria alternata (AA), grass (GP) and olive (OP) pollens. Rhinitis subjects also underwent skin prick test (SPT) with relevant allergens. Patients were classified into allergic rhinitis (AR, positive NAC and SPT), local allergic rhinitis (LAR, positive NAC and negative SPT), dual allergic rhinitis (DAR, defined as AR for ≥1 allergen and LAR for ≥1 allergen), and non-allergic rhinitis (NAR, negative NAC and SPT) phenotypes. BAT with DP, AA, GP and OP was conducted in study individuals and compared with NAC results. A total of 47 AR, 31 DAR, 26 LAR, 12 NAR and 21 control subjects were recruited. The best positivity cut-offs of BAT for DP-, AA-, GP- and OP-driven allergy (all phenotypes) were a %CD63 cells of 8.650, 14.250, 26.200, and 12.780, respectively (AUC 0.851, 0.701, 0.887, and 0.921, respectively). Sensitivity, specificity, negative and positive predictive values of BAT (all phenotypes) ranged 43.5%(AA)-83.3%(OP), 88.9%(GP)-100%(AA), 87%(GP)-100%(AA), and 61.1%(DP)-80.0%(pollens), respectively. BAT identified 79%-100% of SPT-positive allergies (AR and DAR), and 25%-75% of SPT-negative allergies (LAR and DAR), while ≤10% of NAR/HC subjects tested positive. BAT positivity correlated with rhinitis severity in LAR patients (p = 0.018), and associated with conjunctivitis (p = 0.015) in allergic subjects. BAT can replace NAC for AR confirmation, and limit the number of NAC required for LAR and DAR diagnosis. BAT can demonstrate sIgE in SPT-negative allergies.

Discrepancy in the suppressive function of regulatory T cells in allergic asthmatic vs. allergic rhinitis subjects upon low-dose allergen challenges.

Regulatory T cells (Tregs) contribute to the maintenance of immunological tolerance. There is evidence of impaired function of these cells in people with asthma and allergy. In this study, we evaluated and compared the function of Tregs in allergic asthmatic and allergic non-asthmatic patients, both before and after low-dose allergen challenges. Three groups of subjects were recruited for a baseline evaluation: healthy controls without allergy or asthma, allergic asthmatic subjects, and allergic non-asthmatic subjects. All of them were subjected to expiratory flow measurements, sputum induction, and blood sampling. In addition, both groups of allergic subjects underwent low-dose allergen challenges. Tregs were isolated from whole blood using CD4+CD25high and CD127low staining. The suppression function was measured by flow cytometry. The levels of IL-10, IFN-γ, IgG4, IgA, and TGF-β were measured using ELISA, and sputum Foxp3 was evaluated using qRT-PCR. The suppressive function of Tregs in healthy controls was significantly higher than in allergic asthmatic or allergic non-asthmatic subjects. Repeated exposure to low doses of allergen increased the suppressor function of Tregs in allergic non-asthmatic subjects but decreased it in allergic asthmatic subjects. Foxp3 gene expression was increased in induced sputum in allergic non-asthmatic subjects, whereas it did not change in asthmatic subjects. Serum IL-10 level was decreased in allergic asthmatic subjects after allergen challenge but not in allergic non-asthmatic subjects. IFN-γ level increased upon allergen challenge in allergic non-asthmatic subjects. IgG4 level was higher in allergic non-asthmatic subjects than in allergic asthmatic subjects. Low-dose allergen challenges stimulate the suppressor function of Tregs in non-asthmatic allergic subjects but not in allergic asthmatic subjects.

Parallel Assessment of Seasonal Allergic Rhinitis Subjects Using 4 and 6-point Symptom Score Assessments

Standardization of outcome measures in allergic rhinitis is essential to achieve a common basis for interpretation of the results of clinical trials. International position statements have proposed a state of the art 4-point severity score scale for symptom assessment. The efficacy of powder Hydroxyl-Propyl-Methyl-Cellulose (pHPMC) in subjects with seasonal allergic rhinitis (SAR) was assessed using both 4- and 6-point scoring scales.

Signals from the TAFA4-PTEN-PU.1 axis alleviate nasal allergy by modulating the expression of FcεRI in mast cells.

The high-affinity IgE receptor, FcεRI, plays a key role in the antigen-induced mast cell activation. Regulations for FcεRI are not yet well understood. TAFA4 is a molecule derived from neuron tissues, and has immune regulation functions. This study aims to clarify the role of TAFA4 in the regulation of FcεRI expression in mast cells. Nasal secretions were collected from patients with allergic rhinitis (AR) and healthy control (HC) subjects. TAFA4 levels of nasal secretions were evaluated by ELISA. A mouse model AR was developed using ovalbumin as the specific antigen. Negative correlation between TAFA4 and tryptase levels in nasal secretions was observed. TAFA4 could suppress the antigen-related mast cell activation. TAFA4 modulated the transcription of Fcer1g (FcεRI γ gene) in mast cells. Signals from the TAFA4-PTEN-PU.1 axis restricted FcεRI expression in mast cells. Administration of TAFA4 attenuated experimental AR. TAFA4 suppressed the expression of FcεRI in mast cells of airway tissues. TAFA4 can down regulate the expression of FcεRI in mast cells to suppress experimental AR. The data suggest that TAFA4 has translation potential to be developed as an anti-allergy therapy.

Sensitivity caused by Dermatophagoides pteronyssinus and D. farinae (Astigmata: Pyroglyphidae) in subjects with allergic rhinitis

The house dust mites (HDMs), defined here as members of the family Pyroglyphidae, are present just about everywhere in human dwellings and act as an important risk factor for allergic rhinitis (AR). They are a major perennial allergen source that causes AR. In the present study, 160 subjects clinically diagnosed with AR from the Department of Ear Nose Throat (ENT), Government Rajindra Medical College and Hospital, Patiala, India, and 30 non-allergic healthy, control individuals were selected. Blood samples were taken from all these study subjects for serological testing and ImmunoCAP™ Phadia™ 100 was used for the detection of total and HDM specific immunoglobulin E (IgE) levels. To detect total IgE levels, a mixture of 14 different allergens was used and, for HDM specific IgE, a mixture of Dermatophagoides pteronyssinus (Trouessart) and D. farinae Hughes allergens. Dust samples were taken from mattresses used by the study subjects with the help of a vacuum cleaner. A floatation method was used for the extraction of mites. Hoyer’s medium was used for the preparation of slides for microscopy. Total IgE levels were elevated in all AR subjects and HDM specific IgE levels were found to be positive in 54.38% of them. Analysis of dust samples showed that 72.50% of samples from the mattresses of AR subjects were found to be positive for the HDMs D. pteronyssinus and D. farinae and 33.33% of those from the control group. Total and HDM specific IgE levels of AR subjects showed statistically significant correlation with each other, but in the control group no such correlation was found. Moreover, a significant result was found between the positive HDM specific IgE levels and the number of D. pteronyssinus and D. farinae found in their respective dust samples. In conclusion, the total IgE and positive HDM specific IgE levels showed that there was a chance of allergic reaction in rhinitis subjects. Furthermore, the significant statistical analysis between positive HDM specific IgE levels against D. pteronyssinus and D. farinae, and the higher prevalence of these two species in the houses sampled provided support for these mites being the major allergen sources for the symptoms of AR in the study area.

Comparison of circulating fibrocytes from non-asthmatic patients with seasonal allergic rhinitis between in and out of pollen season samples

BackgroundAllergic rhinitis is a risk factor for asthma development. In asthma, fibroblast progenitors, fibrocytes, are increased in the blood and bronchial mucosa following allergen exposure. These cells may play a role in lower airways remodeling as observed in non-asthmatic subjects with allergic rhinitis.ObjectiveTo determine the influence of seasonal allergen exposure on blood circulating fibrocytes in allergic rhinitic subjects without asthma.MethodsNon-asthmatic subjects with seasonal allergic rhinitis had blood sampling at baseline and at the peak of rhinitis symptoms. Cells were stained for fibrocyte markers (CD34, CD45, CXCR4, collagen I) and analyzed by flow cytometry.ResultsData from 26 subjects (11M:15F) aged 29 ± 8 years were analysed. Compared to baseline, there was a significant decrease in blood fibrocytes during the pollen season in subjects sensitized to trees [median (25–75 percentile), 9.3 (6.4–20.7)% vs 7.0 (4.2–10.1)%, P = 0.007] and a significant increase in subjects sensitized to grass [12.7 (9.9–23.1)% vs 64.0 (57.6–73.6)%, P < 0.001] and ragweed [8.0 (7.4–10.8)% vs 48.2 (43.5–52.6)%, P < 0.001]. A significant decrease in CXCR4 mean fluorescence was also observed between the two visits [1814 (1261–2235) vs 1352 (814–1796) (arbitrary units), P = 0.02].Conclusions and clinical relevanceThese results contribute to document dynamic variations in blood fibrocytes’ activation and migration into the airways following natural exposure to allergens. These findings may help identify one of the potential factors involved in the development of asthma in allergic rhinitic subjects.

Effects of Acute Alcohol Intake on Nasal Patency

Acute alcohol intake may influence nasal patency; however, there is lack of objective evidence. The aim of this study was to evaluate the effects of acute alcohol intake on nasal patency employing both subjective and objective measures. A total of 31 participants were classified into 2 groups of non-heavy drinkers (n = 17) and heavy drinkers (n = 14). Both groups consumed wine in 1 h and were assessed for subjective nasal symptoms and objective nasal patency, using rhinomanometry and acoustic rhinometry, at baseline and at 0.5, 2, and 6 h post-alcohol consumption. Alcohol consumption significantly increased nasal obstruction from baseline values in both heavy and non-heavy drinking groups. Total nasal volume (TNV) and the minimal cross-sectional area (MCA) were significantly decreased and nasal airway resistance (NAR) significantly increased from baseline values by 2 h post-alcohol consumption for both heavy and non-heavy drinking groups (P < .05). Significant differences were found in TNV, MCA, and NAR between baseline and post-drinking in allergic rhinitis subjects; with no significant differences in MCA and NAR in subjects without allergic rhinitis. Pulse rate (PR) and temperature (T) were elevated, and blood pressure (BP) was decreased after alcohol consumption (P < .05). Blood alcohol concentration (BAC) was not significantly correlated with nasal patency with regard to any subjective or objective measurement. Acute alcohol consumption may impair nasal patency, independent of the amount consumed. Individuals with allergic rhinitis may be more prone to nasal obstruction after alcohol consumption than those without allergic rhinitis.

Trajectories of early-onset rhinitis in the Singapore GUSTO mother-offspring cohort.

The natural history of childhood rhinitis is not well described. This study aimed to identify different rhinitis trajectories in early childhood and their predictors and allergic associations. Rhinitis symptoms were ascertained prospectively from birth until 6years using standardized questionnaires in 772 participants. Rhinitis was defined as one or more episodes of sneezing, runny and/or blocked nose >2weeks duration. Latent trajectories were identified using group-based modelling, and their predictive risk factors and allergic associations were examined. Three rhinitis trajectory groups were identified: 7.6% (n=59) were termed early transient rhinitis, 8.6% (n=66) late transient rhinitis, and 6.6% (n=51) persistent rhinitis. The remaining 77.2% (n=596) were classified as non-rhinitis/reference group. Early transient rhinitis subjects were more likely of Indian ethnicity, had siblings, reported childcare attendance, early wheezing and eczema in the first 3years of life. Late transient rhinitis was associated with antenatal exposure to smoking, higher maternal education levels, andwheezing at age 36-72months. Persistent rhinitis was associated with male gender, paternal and maternal history of atopy, eczema, and house dust mite sensitization. Risk factors for early transient rhinitis involve a combination of genetic and early environmental exposures, whereas late transient rhinitis may relate to maternal factors and early respiratory infections independent of atopy. In contrast, persistent rhinitis is strongly associated with atopic risk and likely represents the typical trajectory associated with allergic disorders. Allergic rhinitis symptoms may commence as early as the first year of life and may inform development of early interventive strategies.

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.

Nasal specific IgE to Der p is not an acceptable screening test to predict the outcome of the nasal challenge test in patients with non-allergic rhinitis

ObjectivesNasal specific IgE (NsIgE) is the most common marker to identify type-2 inflammation in local allergic rhinitis (LAR). However, the comparison of NsIgE in different types of rhinitis, its frequency in tropical countries, and its diagnostic performance for predicting the outcome of a nasal challenge test (NCT) has had limited study. The main objective of this study was to explore the diagnostic performance of NsIgE to Dermatophagoides pteronyssinus (Der p) among different types of rhinitis and control subjects in a tropical population. MethodsWe evaluated the frequency of NsIgE, systemic atopy (serum sIgE and Skin Prick Test), and nasal eosinophils, and we performed nasal challenge tests (NCTs) with Der p in 3 groups of patients; rhinitis without atopy (RWoA) (n = 25), rhinitis with atopy (RWA) (n = 25), and control subjects (n = 18). ResultsNsIgE had a low sensitivity and specificity to predict a positive NCT in the RWoA group: 48% had NsIgE, but only 28% had a positive NCT. Among the RWA group 84% had NsIgE and 80% had a positive NCT; the association of NsIgE and positive NCT was high (>80%). In the control group 27.8% had NsIgE, but none had a positive NCT. ConclusionsNsIgE performs poorly in predicting NCT results in patients with non-allergic rhinitis. More methodical investigations are needed in this complex area of rhinitis. In patients with allergic rhinitis, NsIgE was useful in predicting a positive nasal challenge, but not superior to the systemic atopic test.

Comparing the nasal bacterial microbiome diversity of allergic rhinitis, chronic rhinosinusitis and control subjects.

Until now, the microbiome of the nasal cavity and its contribution to nasal mucosal disease has remained poorly understood. The advent of cultivation-free molecular methods makes it possible to characterize the total microbiome of the nasal cavity. We sought to assess the microbial diversity and composition of the middle meatus in allergic rhinitis (AR) patients, chronic rhinosinusitis patients without polyps (CRSsNP) and a control population to determine the microbiota associated with the pathogenesis of AR and CRSsNP. Microbial characterization was determined using 16S rRNA gene sequencing of 122 nasal swabs collected from patients with AR (n = 52) and CRSsNP (n = 37), and from healthy controls (n = 33). There was no difference in nasal microbiome richness and diversity among the three groups, and the dominant phyla were similar among three groups including Firmicutes, Proteobacteria, Actinobacteria and Bacteroidetes. However, Spirochaetae abundance was significantly higher in AR than in the control group after FDR correction (FDR p = 0.021). At the genus level, although there was no statistical significance after FDR correction, there was a trend that Pseudomonas and Peptostreptococcaceae abundance were higher in AR than in controls (p = 0.005, p = 0.005) and CRSsNP (p = 0.023, p = 0.034); Lactobacillus abundance was lower in AR than in controls (p = 0.021); Moraxella abundance was lower in CRSsNP than in controls (p = 0.006); Haemophilus abundance was higher in CRSsNP than in AR (p = 0.003) but lower in AR than in controls (p = 0.018). These results suggested that microbial dysbiosis may play a role in the pathogenesis of heterogeneous nasal mucosal inflammation.

Nasal IgE in subjects with allergic and non-allergic rhinitis

PurposeThe prevalence of "ocal allergic rhinitis" within individuals suffering from perennial rhinitis remains uncertain, and patients usually are diagnosed with non-allergic rhinitis. The aim of this study was to evaluate the prevalence of a potential "local allergic rhinitis" in subjects suffering from non-allergic rhinitis in a non-selected group of young students. Methods131 students (age 25.0 ± 5.1 years) with a possible allergic rhinitis and 25 non-allergic controls without rhinitis symptoms (age 22.0 ± 2.0 years) were recruited by public postings. 97 of 131 students with rhinitis were tested positive (≥3 mm) to prick testing with 17 frequent allergens at visit 1. Twenty-four 24 subjects with a house dust mite allergy, 21 subjects with a non-allergic rhinitis, and 18 non-allergic controls were further investigated at visit 2. Blood samples were taken, and nasal secretion was examined. In addition, all groups performed a nasal provocation test with house dust mite (HDM). ResultsIn serum and nasal secretion, total IgE and house dust mite specific IgE significantly differed between HDM positive subjects and controls. However, no differences between non-allergic subjects and control subjects were quantifiable. Neither a nasal provocation test nor a nasal IgE to HDM allergens showed a measurable positive response in any of the non-allergic rhinitis subjects as well as the healthy controls, whilst being positive in 13 subjects with HDM allergy. ConclusionsNasal IgE is present in subjects with HDM allergy, but not in non-allergic rhinitis. In the investigated non-selected population, exclusive local production of IgE is absent. By implication, therefore, our findings challenge the emerging concept of local allergic rhinitis.Study identifier at ClinicalTrials.gov: NCT 02810535.

Personality Profiles in Patients With Allergic Rhinitis

Background: Psychological factors can be associated with allergic disorders. However, no particular personality pattern associated with these disorders has yet been identified. Objectives: This study aimed at comparing the personality profiles of patients with perennial allergic rhinitis and normal controls. Materials &amp; Methods: This cross-sectional study was done on 50 adult people with persistent allergic rhinitis for at least one year and 50 age- and sex-matched normal controls that completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). A multivariate covariance analysis (MANCOVA) was carried out to discover possible personality differences between the two groups. The data were analyzed by SPSS v. 19 software. Results: The results of the MMPI showed no significant difference between the two groups in the validity scales (P=0.29). The most common modal validity presentation style in both groups was neutral self-presentation. The MANCOVA analysis showed significantly high scores on the hypochondriasis (F=18.13, P&lt;0.005, partial η2 =0.16) and hysteria scales in allergic rhinitis subjects (F=8.68, P=0.04, partial η2 =0.08) compared with normal controls. The most common profiles with high scores in the allergic rhinitis subjects were schizophrenia (52%, P&lt;0.01) and hypochondriasis (50%, P&lt;0.01). These scales emphasized the feelings of isolation and discomfort in allergic people. The frequency of psychasthenia scale, which measures long lasting anxiety, was significantly different between the two groups (40% in allergic rhinitis subjects vs. 10% in normal controls, odds ratio=6 [95%CI 1.9-22.3], P&lt;0.001). Conclusion: The score of psychological health is lower among allergic people than in normal contro

Nasal Provocation Test with Cat and Dog Extracts: Results according to Molecular Components.

Background IgE sensitization (atopy) to pets is commonly evaluated using pet dander extracts. However, the diagnosis by components seems to be more adequate to evaluate the clinical relevance (allergy) of sIgE sensitization. Objective To study the association between IgE sensitization to pet allergen components and clinical symptoms. Methodology. Dander extracts and sIgE levels to pet components (Can f 1, Can f 2, Can f 3, Can f 5, Fel d 1, Fel 2, and Fel 4) were measured in a rhinitis group (n = 101) and a control group (n = 101) and a control group (Results Dog (34.6% vs. 23.5%) and cat dander (26.7% vs. 8.8%, p = 0.05) IgE sensitization was frequent among rhinitis and no-rhinitis subjects, and it was similar to dog (29.7% vs. 20.5%) and cat (18.8% vs. 8.8%) components. Polysensitization for dog (3.1, 95% CI: 1.5 to 6.1, p = 0.05) IgE sensitization was frequent among rhinitis and no-rhinitis subjects, and it was similar to dog (29.7% vs. 20.5%) and cat (18.8% vs. 8.8%) components. Polysensitization for dog (3.1, 95% CI: 1.5 to 6.1, p = 0.05) IgE sensitization was frequent among rhinitis and no-rhinitis subjects, and it was similar to dog (29.7% vs. 20.5%) and cat (18.8% vs. 8.8%) components. Polysensitization for dog (3.1, 95% CI: 1.5 to 6.1, Conclusions Sensitization to pet dander extract identifies atopic patients, but its utility to predict clinical relevance is poor. Allergenic components could help to define the clinical relevance of sensitization to furry animals and could reduce the need for provocation test.

IL-17C expression and its correlation with pediatric adenoids: a preliminary study.

Objective: Interleukin-17 (IL-17) C is a cytokine expressed by epithelial cells in response to bacterial stimulation. In contrast to other members of the IL-17 family of cytokines, IL-17C is upregulated early during infection, maintains integrity of the epithelial layer barrier, and mediates the innate immune response. We investigated the expression profile of IL-17C in pediatric adenoids.Methods: Pediatric adenoid tissues and lavage fluids were collected from a total of 38 subjects. The Limulus amebocyte lysate test and real-time PCR using Staphylococcus aureus primers were performed to evaluate bacterial contents in adenoids. Expression of IL-17RE in adenoids was analyzed using real-time polymerase chain reaction and western blot. The expression of IL-17C was evaluated by western blot and immunohistochemistry and compared between allergic rhinitis (AR) and control subjects. The levels of Hsp27, Hsp70, and IL-17C in adenoid lavage fluids were evaluated by enzyme-linked immunosorbent assay, and the correlation between these molecules was statistically analyzed.Results: The pediatric adenoids were found to be exposed to bacteria and had a normal flora comprising both gram-negative and -positive bacteria. IL-17RE, an IL-17C specific receptor, was highly expressed in the epithelium of adenoids. IL-17C was expressed in all evaluated adenoid tissue samples, irrespective of the allergic status of the patient. IL-17C secretion was detected in half of the adenoid lavage fluid samples and was associated with Hsp70 level.Conclusion: Our findings indicate the possible role of pediatric adenoids in innate immunity modulation via an innate immunity-associated cytokine.

Expansion of different subpopulations of CD26\u2212/low T cells in allergic and non-allergic asthmatics

CD26 displays variable levels between effector (TH17 ≫ TH1 > TH2 > Treg) and naïve/memory (memory > naïve) CD4+ T lymphocytes. Besides, IL-6/IL−6R is associated with TH17-differentiation and asthma severity. Allergic/atopic asthma (AA) is dominated by TH2 responses, while TH17 immunity might either modulate the TH2-dependent inflammation in AA or be an important mechanism boosting non-allergic asthma (NAA). Therefore, in this work we have compared the expression of CD26 and CD126 (IL-6Rα) in lymphocytes from different groups of donors: allergic (AA) and non-allergic (NAA) asthma, rhinitis, and healthy subjects. For this purpose, flow cytometry, haematological/biochemical, and in vitro proliferation assays were performed. Our results show a strong CD26-CD126 correlation and an over-representation of CD26− subsets with a highly-differentiated effector phenotype in AA (CD4+CD26−/low T cells) and NAA (CD4−CD26− γδ-T cells). In addition, we found that circulating levels of CD26 (sCD26) were reduced in both AA and NAA, while loss of CD126 expression on different leukocytes correlated with higher disease severity. Finally, selective inhibition of CD26-mRNA translation led to enhanced T cell proliferation in vitro. These findings support that CD26 down-modulation could play a role in facilitating the expansion of highly-differentiated effector T cell subsets in asthma.

Toll-like receptor signal is required in maintenance of immune suppressive capacity of regulatory T cells

Dysfunction of immune regulatory cells has been recognized in a variety of immune diseases; the underlying mechanism remains to be further investigated. This study aims to investigate the critical role of Toll-like receptor (TLR) signal in the maintenance of function of regulatory T cells (Tregs). In this study, Tregs were isolated from patients with allergic rhinitis (AR) and healthy control (HC) subjects. The role of TLR signal in the maintenance of Treg’s function was tested with experiments of cell culture and an AR mouse model. We observed that the immune suppressive function of AR Treg (Tregs isolated from AR patients) was impaired, although the number of peripheral AR Treg was comparable with HC Treg. Expression of transforming growth factor (TGF)-β was lower in AR Tregs than that in HC Tregs that was positively correlated with expression of Mal in Tregs; the latter was lower in AR Tregs as compared to HC Tregs. TGF-β mRNA in Tregs decayed spontaneously in the culture. Activation of Mal counteracted TGF-β decay and maintained the Treg’s immune regulatory function. Mal bound Tristetraprolin (TTP) to prevent TTP from inducing TGF-β mRNA decay. Absence of TLR signals resulted in Treg dysfunctional and worsened experimental AR response in a murine model. In conclusion, TLR signal is required in the maintenance of Treg function. Absence of TLR signal may result in Treg dysfunction and immune intolerance.

Nasal Nitric Oxide Is Correlated With Nasal Patency and Nasal Symptoms.

PurposeNitric oxide (NO) is an important endogenous mediator in both upper and lower respiratory systems. The purpose of the present study was to extract nasal NO (nNO) normal range of Chinese adults and the internal influencing factors. The differences in nNO levels between rhinitis and asymptomatic atopic subjects, and the diagnostic value of nNO in allergic rhinitis (AR) were further investigated.MethodsOne thousand adults were recruited from the general public. Participants were divided into different subgroups according to the questionnaires and skin prick tests. In all of these subjects, nNO, fractional exhaled NO (FeNO) and nasal airflow resistance were measured. The normal ranges of nNO and FeNO, the differences between subgroups, and the correlations between NO (nNO and FeNO) and other internal factors were analyzed.ResultsBoth nNO and FeNO levels were significantly higher in AR patients than in healthy and asymptomatic atopic subjects. The nNO levels were significantly lower in asymptomatic atopic subjects than in normal adults. FeNO levels were significantly higher in non-AR patients than in the healthy and asymptomatic atopic adults. The cutoff value of nNO for the diagnosis of AR was 117.5 ppb (sensitivity, 50.9%; specificity, 63.9%). The nNO levels were correlated with FeNO levels, total nasal resistance measured at 75Pa, nasal volume within 0–7 cm from the anterior nares (V0–7cm) and nasal symptom visual analogue scale (VAS) scores, while the FeNO levels were correlated with age, height, weight, body surface area, nasal volume of V0–7cm and the nasal symptom VAS score.ConclusionsThe nNO level can be significantly different between healthy and AR patients and may be significantly correlated with nasal symptoms and nasal patency of rhinitis patients. However, the clinical value of nNO is still in the exploration stage.

The clinical burden of allergic rhinitis in five Middle Eastern countries: results of the SNAPSHOT program

BackgroundThe SNAPSHOT program provides current data on the allergic rhinitis burden in the adult general population of five Middle Eastern countries (Egypt, Turkey, Kuwait, Saudi Arabia and the United Arab Emirates, the latter three grouped into a Gulf cluster).MethodsA multi-country, cross-sectional, epidemiological program conducted by telephone in a random sample of the adult general population; quotas were defined per country demographics. Subjects were screened for allergic rhinitis using the Score For Allergic Rhinitis questionnaire. Current prevalence (last 12 months) was estimated. Disease severity and control were assessed using the Allergic Rhinitis and its Impact on Asthma classification and Rhinitis Control Assessment Test respectively. Quality of sleep, impact on daily activities and quality of life were measured using the Epworth Sleepiness Scale, Sheehan Disability Scale and EuroQol Five-Dimension questionnaire respectively. Multivariate logistic regression analyses were used to investigate risk factors and co-morbidities.Results1808 of 33,486 subjects enrolled in the SNAPSHOT program fulfilled the case definition for allergic rhinitis. Prevalence was 3.6% [95% CI 3.2–4.0%] in Egypt, 6.4% [95% CI 5.9–6.9%] in Turkey and 6.4% [95% CI 6.0–6.9%] in the Gulf cluster. Risk factors identified were country, co-morbid asthma and income. Subjects with allergic rhinitis reported a significantly lower quality of life compared to the general population (p < 0.0001). Overall, 55% of allergic rhinitis subjects were moderate/severe and 33% were uncontrolled. Both these groups reported impaired quality of life and quality of sleep and increased impairment of daily activities compared to mild/well-controlled subjects (p < 0.0001).ConclusionsAlthough the observed prevalence of allergic rhinitis in these Middle Eastern countries is low compared to western countries, its burden is considerable. Allergic rhinitis in general, and specifically uncontrolled and severe disease, results in a negative impact on quality of life, quality of sleep and daily activities.

Efficacy of snakehead fish (Channa striatus) in subjects with allergic rhinitis: a randomized controlled trial

Allergic rhinitis is a prevailing chronic inflammatory respiratory disorder that affects 10–30% of the population globally. Channa striatus (Channa) is a snakehead, freshwater fish that has been used traditionally to enhance wound healing and relief post-operative pain. This study evaluates the efficacy of oral Channa extract on allergic rhinitis subjects on total nasal symptom score and serum immunoglobulin E (Ig E). A randomized, double-blind, placebo-controlled trial was conducted by comparing the oral Channa extract 500 mg/day and placebo among allergic rhinitis subjects for a 6-week intervention period. Subjects aged 18–50 years old, diagnosed with allergic rhinitis based on total symptoms score, naso-endoscopy findings, and positive skin prick test were included in this trial. All subjects were treated with antihistamine (levocetrizine) and local corticosteroid nasal spray (fluticasone furoate nasal spray). Laboratory-based blood tests were used as safety measures. A total of 70 subjects were randomized. Channa group showed significant improvement in nasal blockage (p < 0.05), nasal itchiness (p < 0.05), eye itchiness (p < 0.05) and general symptoms (p < 0.05) compared to the placebo groups. Serum Ig E were significantly lowered in Channa group compared to placebo (p < 0.001). No significant differences were found between the groups in terms of nasal discharge, sneezing, palate itchiness, and smell score. No serious adverse events were reported. In conclusion, Channa has a beneficial role in improving nasal symptoms and reduction in serum Ig E in allergic rhinitis subjects.