Severe Rhinorrhea Research Articles

Comparison of clinical traits for seasonal and perennial allergic rhinitis during allergen exposure.

Background: Allergic rhinitis (AR) is traditionally subdivided into seasonal AR (SAR) and perennial AR (PAR) according to the type of allergen and the occurrence of symptoms during the year. There are currently no reports on the comparison of trait profiles for SAR and PAR during the allergen exposure. Purpose: The purpose of this study was to analyze the clinical characteristics of SAR and PAR during respective allergen exposure periods to provide valuable information for the development of treatment strategies. Methods: This study was performed between August 1, 2021, and January 31, 2022, in the Department of Allergy, Beijing Tongren Hospital. We continuously included diagnosed SAR and PAR outpatients who volunteered to participate in the survey. A questionnaire with regard to medical history, severity of symptoms, and diagnosis and treatment status was collected. Results: A total of 296 patients with SAR and 448 with PAR were finally recruited. Patients with SAR had more severe rhinorrhea compared with patients with PAR (p < 0.001), whereas there was no statistically significant difference in the severity of itching, sneezing, and congestion between the two entities (p ≥ 0.05). Both the gritty and watery eyes of patients with SAR were noticeably more severe than those of patients with PAR (PTotal Ocular Symptom Score [PTOSS] < 0.001). AR symptom severity is mainly associated with the comorbid allergic conjunctivitis (odds ratio 1.94 [95% confidence interval, 1.21-3.09]). SAR patients and PAR patients show no statistically significant differences in terms of their frequency of visits, annual expenditure, and choice of medication treatment for AR (p > 0.05). The overall control under standard medication of both patients with PAR and those with SAR is not ideal, especially in SAR. Conclusion: The current cross-sectional study demonstrated that the patients with SAR exhibited more severe overall clinical symptoms than those with PAR, especially nasal rhinorrhea and gritty and watery eyes. Both of the two disease entities have poor control under standardized medication treatment, especially in SAR. Further multicenter longitudinal studies that involve larger and more diverse populations should be conducted to provide a more accurate and comprehensive understanding of the condition.

Effect of Radiofrequency Neurolysis on the Symptoms of Chronic Rhinitis: A Randomized Controlled Trial.

ObjectiveTo determine the safety and efficacy of temperature-controlled radiofrequency (RF) neurolysis of the posterior nasal nerve (PNN) area for the treatment of chronic rhinitis.Study DesignA multicenter, prospective, single-blinded, randomized controlled trial, in which the control arm underwent a sham procedure.SettingSixteen otolaryngology centers.MethodsPatients with 24-hour reflective Total Nasal Symptom Score (rTNSS) ≥6, including moderate to severe rhinorrhea and mild to severe congestion, were randomized 2:1 to active treatment of the posterior nasal nerve area with a temperature-controlled RF device or a sham procedure, with no RF energy delivery. The stylus was applied bilaterally to nonoverlapping areas of the posterior middle meatus and posterior inferior turbinate in each nostril in the region of the PNN. The primary endpoint was responder rate at 3 months, where a response was defined as ≥30% improvement (decrease) in rTNSS from baseline.ResultsPatients had a mean baseline rTNSS of 8.3 (95% CI, 7.9-8.7) and 8.2 (95% CI, 7.6-8.8) (P = .797) in the active treatment (n = 77) and sham control (n = 39) arms, respectively. At 3 months, responder rate was significantly higher in the active treatment arm: 67.5% (95% CI, 55.9%-77.8%) vs 41.0% (95% CI, 25.6%-57.9%) (P = .009). The active treatment arm had a significantly greater decrease in rTNSS (mean, −3.6 [95% CI, −4.2 to −3.0] vs −2.2 [95% CI, −3.2 to −1.3]) (P = .013). Three adverse events related to the device/procedure were reported, and all resolved.ConclusionThis randomized controlled trial showed temperature-controlled neurolysis of the PNN area is free from significant adverse events and superior to a sham procedure in decreasing the symptom burden of chronic rhinitis.

A case of anaphylaxis presumably caused by a trace amount of povidone in a tablet pill

Povidone, also known as polyvinylpyrrolidone has high sterilizing power and low toxicity, and has been widely used in disinfectants, ointments, gels, shampoos, soap, and pharmaceutical tablet additives. Povidone-iodine (Betadine) is a rare cause of IgE-mediated allergy, and to our best of knowledge there have been no reports in Korea. We report the first case of anaphylaxis in Korea presum ably caused by a trace amount of povidone contained in a tablet pill. An 18-year-old man experienced severe rhinorrhea, nasal con gestion, eyelid swelling, cough, and dyspnea after taking multiple drugs at the same time for abdominal pain and diarrhea 20 days before the hospital visit. Symptoms disappeared after the treatment. He experienced similar symptoms after applying povidone to skin wounds 2 years ago. Among the drugs taken, these symptoms were assumed to be caused by a drug containing a trace amount of povidone. The remaining drug was tested by oral provocation, and there were no adverse reactions. He has avoided drugs containing povidone and has not experienced similar reactions for more than 1 year since then. Therefore, it is presumed that a systemic hypersensitivity reaction may occur due to a very small amount of povidone in a tablet pill. (Allergy Asthma Respir Dis 2021;9:99-103)

An open-label, multicentre, randomized comparative study of efficacy, safety and tolerability of the 5 plant - extract BNO 1012 in the Delayed Antibiotic Prescription Method in children, aged 6 to 11 years with acute viral and post-viral rhinosinusitis

292 children aged 6 to 11 years with ARS were randomized in the multicenter, comparative study. They received an extract of five medicinal plants in addition to standard symptomatic therapy or standard therapy only. EVALUATION CRITERIA: reduction of the sinusitis severity according to a 4-point medical assessment scale (nasal congestion, severity of anterior and posterior rhinorrhea) at each visit, dynamics of self-scoring of rhinorrhea and headache (according to a 10-point visual analogue scale), "therapeutic benefit" in days, frequency of antibiotic prescriptions due to the use of an extract of five plants. The use of the 5-plant extract BNO 1012 in addition to the standard symptomatic treatment of acute rhinosinusitis provides a clinically significant, adequate reduction in the severity of rhinorrhea, nasal congestion and post-nasal drip, assessed by a physician at V2 (p < 0.005). Significant differences are noted in the patient's self-scoring of rhinorrhea on the second or third day in viral RS, and from the fourth to the eighth day in post-viral RS. Symptoms of similar intensity in control group were observed at V3. Thus, in the first week of treatment, the treatment group compared to the control one showed a "therapeutic benefit" of three days. The use of BNO 1012 in patients with acute rhinosinusitis can 1.81-fold reduce the prescription of antibacterial drugs. The combination of five medicinal plants is effective for the treatment of acute rhinosinusitis in children aged 6 to 11 years. Its use provides a significant "therapeutic benefit" when administered in addition to standard symptomatic therapy, reducing the need for antibiotic use.

Correlation of Nasal Eosinophilia and Response after Nasal Provocation Test in Patients with Nonallergic Rhinitis.

Objectives We aimed to evaluate the relationship between nasal eosinophilia and nasal hyperresponsiveness to allergen extract. Study Design Retrospective chart review. Setting Academic tertiary rhinologic practice. Subjects and Methods We performed allergy tests (skin prick test and multiple allergosorbent test) and nasal cytology for 194 patients with rhinitis symptoms (76 males and 118 females; age, 11-69 years). According to the results, they were classified into 4 groups: group A (allergic rhinitis with eosinophilia, n = 26), group B (allergic rhinitis without eosinophilia, n = 77), group C (nonallergic rhinitis with eosinophilia syndrome, n = 20), and group D (nonallergic rhinitis without eosinophilia, n = 71). We performed a nasal provocation test (NPT) using house dust mite extract and assessed the changes in symptoms and the decrease in acoustic parameters (total nasal volume and minimal cross-sectional area [MCA]). Results Patients in group C were more likely to have severe rhinorrhea and sneezing than those in group D ( P < .001). After NPT, group C had greater aggravation of nasal obstruction than group D ( P < .001). Group C also showed markedly greater MCA changes as compared with group D 15 minutes after the antigen challenge ( P = .002). There was significant correlation between the number of eosinophils and an increase in nasal obstruction ( r = 0.319, P = .0009), rhinorrhea ( r = 0.302, P = .0017), sneezing ( r = 0.219, P = .0241), change in the total nasal volume 15 minutes after NPT ( r = 0.287, P = .0028), and change in the MCA 15 minutes ( r = 0.322, P = .0008) and 30 minutes ( r = 0.250, P = .0098) after NPT. Conclusion In patients with NAR, nasal eosinophilia is associated with provocative response after NPT. Further research should be performed to elucidate the mechanisms that underlie this phenomenon.

Clinical efficacy of allergen-specific immunotherapy in children with combined forms of respiratory trees pollen allergy

Background. To evaluate the effectiveness of three courses of allergenspecific immunotherapy (ASIT) in children with combined forms of respiratory pollen allergy. Materials and methods. We observed 69 children aged 10,6±0,4 with combined forms of hay fever. All children were randomized and divided into 3 subgroups who received allergen-specific immunotherapy (ASIT) with Fostal, Staloral and water-salted mixed extracts of trees pollen. The comparison group consisted of 16 children with combined forms of hay fever without ASIT. The effectiveness of treatment was assessed by dynamics of the allergic rhino-conjunctivitis symptoms using a visual analogue scale and dynamics of the level of control over the symptoms of bronchial asthma using standardized questionnaires - the Asthma Control Test. Results. The first course of allergen-specific immunotherapy reduced the severity of rhinorrhea by 48%, nasal congestion - by 45,1%, itching eyes - by 40,8%, nasal itching - by 30,6%, complete control of asthma symptoms was achieved in 61,2%; ASIT reduced the likelihood of an uncontrolled flow of asthma in 17,6 times compared with children who did not receive immunotherapy. After three courses of allergen-specific immunotherapy with pollen allergens a decrease of the severity of allergic rhino-conjunctivitis symptoms and increase of the level of asthma symptoms control in all subgroups was shown.

Correlations of nasal responses to leukotriene D4 and histamine nasal provocation with quality of life in allergic rhinitis.

BackgroundThe symptoms of allergic rhinitis (AR) greatly affect the quality of life (QoL) in the patients with AR. The correlations of nasal response to leukotriene D4 (LTD4) and histamine nasal provocation with health related QoL in AR are not clear.ObjectiveTo evaluate the correlations of nasal response to LTD4 and histamine nasal challenge with QoL in AR.MethodsPatients randomly underwent LTD4 and histamine nasal challenge tests, completed the rhinoconjunctivitis quality of life questionnaire (RQoLQ), and rating the symptom severity score (total symptom score 4, TSS4) in the previous week. The correlations between nasal challenge tests induced nasal responses and QoL in RQoLQ were analyzed.ResultsA total of 25 eligible AR patients enrolled and finished both LTD4 and histamine nasal challenge and completed the questionnaire of RQoLQ. Histamine nasal challenge induced sneezing, increased nasal resistant were correlated with most of the dimensions (general, practical, nasal, eye problems, and quality of sleep, p < 0.05), while LTD4 nasal challenge induced sneeze, increased nasal resistant only correlated with nasal and ocular problems. On the contrary, the severity of the sneeze assessed by TSS4, was not correlated with QoL, while the severity of rhinorrhea, congestion, and nasal pruritus were correlated with nasal and practical problems, and nasal congestion was also correlated with ocular problems (r = 0.60, p = 0.01).ConclusionLTD4 and histamine nasal challenge induced nasal responses were correlated with different clinical symptoms severity and QoL, which can be used as a good diagnosis and evaluation methods for the management of AR.

Pollen derived low molecular compounds enhance the human allergen specific immune response invivo.

Besides allergens, pollen release bioactive, low molecular weight compounds that modulate and stimulate allergic reactions. Clinical relevance of these substances has not been investigated to date. To elucidate the effect of a non-allergenic, low molecular weight factors from aqueous birch pollen extracts (Bet-APE<3kDa) on the human allergic immune response invivo. Birch and grass pollen allergic individuals underwent skin prick testing with allergen alone, allergen plus Bet-APE<3kDa, or allergen plus pre-identified candidate substances from low molecular pollen fraction. Nasal allergen challenges were performed in non-atopic and pollen allergic individuals using a 3day repeated threshold challenge battery. Subjects were either exposed to allergen alone or to allergen plus Bet-APE<3kDa. Local cytokine levels, nasal secretion weights, nasal congestion and symptom scores were determined. Skin prick test reactions to pollen elicited larger weals when allergens were tested together with the low molecular weight compounds from pollen. Similar results were obtained with candidate pollen-associated lipid mediators. In nasal lining fluids of allergic patients challenged with allergen plus Bet-APE<3kDa, IL-8 and IgE was significantly increased as compared to allergen-only challenged patients. These patients also produced increased amounts of total nasal secretion and reported more severe rhinorrhea than the allergen-only challenged group. Low molecular compounds from pollen enhance the allergen specific immune response in the skin and nose. They are therefore of potential clinical relevance in allergic patients.

Effectiveness of itraconazole on clinical symptoms and radiologic findings in patients with recurrent chronic rhinosinusitis and nasal polyposis.

Background:This study was done to evaluate the effect of itraconazole on clinical symptoms and radiologic findings in patients with chronic rhinosinusitis and nasal polyposis after surgery.Materials and Methods:In a clinical trial which was conducted in Alzahra and Kashani hospitals, from November 2011 to December 2012, 22 patients with recurrent postsurgical chronic sinusitis and polyposis entered the study. At the start of the study demographic data, subjective clinical symptoms (severity of rhinorrhea, nasal obstruction, hyposmia, and dyspnea), quality of life (QoL) by sinonasal outcome test-20 (SNOT-20), serum immunoglobulin E (IgE), and score of computed tomography (CT) scan (by Lund-Mackay) were recorded. Itraconazole (100 mg, twice per day) prescribed for 3 months and patients were followed in the 1st, 3rd, and 6th months. Liver enzyme tests and side effects were evaluated monthly.Results:Severity of rhinorrhea, nasal obstruction, hyposmia, dyspnea, and QoL (by SNOT-20) improved during 3 months of treatment. Serum IgE was 265 (±277) at the start of the study, and decrease to 193 (±183) after 3 month. After 3 month, Lund-Mackay score of CT scan lowered from 19 (±4) to 15 (±6) (P < 0.05). At the 6th month, severity of clinical symptoms except dyspnea and QoL were better than first evaluation.Conclusion:This study showed the beneficial effect of 3-month itraconazole treatment on clinical symptoms and radiologic findings and QoL in patients with recurrent postsurgical chronic rhinosinusitis and nasal polyposis.

Intranasal ipratropium bromide for the common cold.

The common cold is one of the most common illnesses in humans and constitutes an economic burden both in terms of productivity and expenditure for treatment. There is no proven cure for the common cold and symptomatic relief is the mainstay of treatment. The use of intranasal ipratropium bromide (IB) has been addressed in several studies and might prove an effective treatment for the common cold. To determine the effect of IB versus placebo or no treatment on severity of rhinorrhoea and nasal congestion in children and adults with the common cold. Subjective overall improvement was another primary outcome and side effects (for example, dry mucous membranes, epistaxis and systemic anticholinergic effects) were reported as a secondary outcome. In this updated review we searched CENTRAL 2013, Issue 3, MEDLINE (1950 to March week 4, 2013), MEDLINE in-process and other non-indexed citations (8 April 2013), EMBASE (1974 to April 2013), AMED (1985 to April 2013), Biosis (1974 to February 2011) and LILACS (1985 to April 2013). Randomised controlled trials (RCTs) comparing IB to placebo or no treatment in children and adults with the common cold. Two review authors independently extracted data and assessed trial quality. We used a standardised form to extract relevant data and we contacted trial authors for additional information. Seven trials with a total of 2144 participants were included. Four studies (1959 participants) addressed subjective change in severity of rhinorrhoea. All studies were consistent in reporting statistically significant changes in favour of IB. Nasal congestion was reported in four studies and was found to have no significant change between the two groups. Two studies found a positive response in the IB group for the global assessment of overall improvement. Side effects were more frequent in the IB group, odds ratio (OR) 2.09 (95% confidence interval (CI) 1.40 to 3.11). Commonly encountered side effects included nasal dryness, blood tinged mucus and epistaxis. The overall risk of bias in the included studies was moderate. For people with the common cold, the existing evidence, which has some limitations, suggests that IB is likely to be effective in ameliorating rhinorrhoea. IB had no effect on nasal congestion and its use was associated with more side effects compared to placebo or no treatment although these appeared to be well tolerated and self limiting. There is a need for larger, high-quality trials to determine the effectiveness of IB in relieving common cold symptoms.

Is Rhinorrhea an Under-Recognized Intrinsic Symptom of Parkinson Disease? A Prospective Pilot Study

ABSTRACTPurpose: The purpose of this study is to compare the prevalence of idiopathic rhinorrhea in PD patients versus controls, to determine the correlation between rhinorrhea and anosmia, and the factors associated with rhinorrhea. Scope: A cohort of 61 PD patients and 51 age-matched controls completed a survey about rhinorrhea and underwent the University of Pennsylvania Smell Identification Test (UPSIT). We compared the prevalence of idiopathic rhinorrhea in the PD patients versus controls, the correlation between rhinorrhea and anosmia in PD patients, and the factors associated with rhinorrhea in the PD patients. The results of the study are that 6% of controls versus 24% of PD patients had rhinorrhea (p = .03); moreover, only 2% of controls versus 15% of PD patients had severe rhinorrhea. Conclusion: Rhinorrhea is more prevalent in PD patients compared to controls and it does not significantly impact performance on a smell test.

A dose-response study of the efficacy and safety of ipratropium bromide nasal spray in the treatment of the common cold

Rhinorrhea is an annoying symptom of the common cold for which effective therapy is not currently available. Ipratropium bromide (IB) is an anticholinergic drug that has been shown to decrease glandular secretion when applied topically to the nasal mucosa. The purpose of this study was to compare the efficacy and safety of three doses of IB nasal spray versus either vehicle or no treatment in relieving rhinorrhea in patients with naturally acquired colds. Rhinorrhea severity was measured objectively by determining nasal discharge weights and subjectively by means of visual analog scale scores. Compared with either vehicle or no treatment, IB nasal spray produced a significant decrease in the severity of rhinorrhea. A dose of 84 μg (two sprays of a 0.06% solution in buffered saline solution) in each nostril was more efficacious than a 42 μg per nostril dose and only marginally less efficacious than a 168 μg per nostril dose. The 84 μg per nostril dose also was associated with fewer adverse events than was the higher dose. None of the adverse events related to intranasal IB therapy was of a serious nature. The use of IB nasal spray appears to be a rational and safe approach to relieving rhinorrhea associated with the common cold. (J A LLERGY C LIN I MMUNOL 1995;95:1139-46.)

Chronic sinusitis among pediatric patients with chronic respiratory complaints

We examined the prevalence of chronic sinusitis among children who presented to allergy clinics with chronic (⩾ 3 months) respiratory symptoms. Ninety-one patients, ranging from 2 to 17 years of age with 62% male and 72% white, completed the study. Fifty-nine percent of patients had positive skin test results, and 25.3% had chronic asthma. Paranasal sinuses were examined by coronal sinus computed tomographic scan. Sixty-three percent (58 of 91) had chronic sinusitis, 5.5% (5 of 91) had concha bullosa, 1% (1 of 91) had foreign body, and 19% (19 of 91) had deviated nasal septums. Among symptoms of sneezing nasal congestion, postnasal drip, coughing, wheezing rhinorrhea, and headache, no single symptom was an acceptable predictor o f abnormality on computed tomographic scan examinations. Combining the symptoms of moderate to severe rhinorrhea and cough with minimum sneezing had a specificity of 95 % and a sensitivity of 38% in predicting the presence of chronic sinusitis. Allergic rhinitis ( p = 0.27), mild deviated nasal septum ( p = 0.11), unobstructive concha bullosa ( p = 0.13), and passive exposure to cigarette smoke ( p = 0.53) were not risk factors associated with sinus abnormalities. Age ( r = 0.30, p = 0.004) in pediatric patients with chronic respiratory symptoms was the single risk factor significantly associated with abnormalities on sinus computed tomographic scan. Seventy-three percent of children 2 to 6 years of age, 74% of children 6 to 10 years of age, and 38% of children older than 10 had chronic sinusitis. Chronic sinusitis is common among pediatric patients with chronic respiratory symptoms. Because the clinical symptoms are not acceptably sensitive, imaging studies of the sinus such as a Waters' view roentgenogram should be considered as part of an allergy evaluation, especially in a high-risk group o f patients from 2 to 10 years of age.

Nasal secretions in response to acetylsalicylic acid

Background: Acetylsalicylic acid (ASA) induces rhinorrhea in a subset of patients with asthma or chronic rhinosinusitis or both and nasal polyps. The underlying mechanism of the reaction is obscure. Methods: To assess the nasal response to ASA challenge, four groups of patients were challenged orally with ASA: group A (10 ASA-sensitive patients); group B (nine patients with nasal polyps and histories of tolerance to ASA); group C (nine ASA-tolerant patients with chronic allergic rhinitis); and group D (eight healthy nonatopic subjects). Results: Nasal lavages obtained before and after ASA challenge were assayed for proteins (total protein, lactoferrin, lysozyme, albumin) and inflammatory mediators (histamine, prostaglandin D 2, and leukotriene C). ASA challenges induced severe rhinorrhea and congestion and significant increases in mean concentrations of all measured nasal proteins in group A. Histamine and prostaglandin D 2 rose, but not significantly. In the two control groups with chronic rhinitis, ASA induced increases in the concentration of proteins and histamine. Leukotriene C, concentrations were significantly elevated in nasal lavages after ASA challenge in groups A and C only. In group D no symptoms or changes in nasal proteins were observed after aspirin challenge. Conclusions: These observations suggest that production of lipoxygenase products of arachidonate may induce glandular secretions that may participate in the clinical changes associated with ASA sensitivity.

Ipratropium bromide aqueous nasal spray for patients with perennial allergic rhinitis: A study of its effect on their symptoms, quality of life, and nasal cytology

Ipratropium bromide is an anticholinergic agent with topical activity that has been studied as a freon-propelled aerosol spray for therapy of nonallergic rhinitis. This is the first report of its use both as an aqueous nasal spray and in perennial allergic rhinitis. In this study 123 patients who had symptoms of perennial allergic rhinitis were randomized to receive ipratropium bromide 21 μg or 42 μg or placebo, one spray per nostril three times a day for 4 weeks. Patients maintained daily diaries of duration and severity of nasal symptoms and were evaluated weekly. Mean duration and severity of rhinorrhea was decreased in both ipratropium bromide treatment groups by comparison with placebo, with consistently greatest improvement in the group treated with ipratropium bromide 42 μg per nostril three times a day. No statistically significant differences occurred among treatment groups in duration or severity of postnasal drip, congestion, or sneezing. Seventy percent of patients treated with 42 μg of ipratropium bromide thought it had good or excellent effect on rhinorrhea ( p < 0.05 vs placebo); significantly more patients thought that it had improved the quality of life ( p = 0.02). No changes occurred in nasal cytology, and no significant local or systemic adverse events occurred. These data indicate that ipratropium bromide significantly decreases the rhinorrhea of perennial allergic rhinitis.