SESSION TYPE: Asthma PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE:

Allergic rhinitis (AR) and asthma represent a continuum of atopic diseases. Some patients with AR and no clinical evidence of asthma suffered airway hyperresponsiveness (AHR), and may facilitate development of asthma. However, some difficulties existed for Ears-Nose-Throat (ENT) specialists to select appropriate clinical items for screening AHR cases from AR patients without asthma. Our objective was to explore sputum and nasal inflammatory markers, spirometric and acoustic rhinometric measurements for identification of AHR in patients with persistent allergic rhinitis (PER).

METHODS:

Fifty-six patients suffered PER without asthma were selected and evaluated by asthma symptom questionnaire and physical examinations. Then all received nasal and induced sputum eosinophil count, nasal and exhaled nitric oxide measurements, acoustic rhinometry, spirometry and methacholine challenge. The patients were categorized into AHR and non-AHR groups, and statistical analyses were done by SPSS.

RESULTS:

Eighteen (8 males and 10 females) PER patients were confirmed with AHR and 38 (21 males and 17 females) without AHR by methacholine challenge. A higher percentage of the patients with AHR had nasal eosinophilia (1+~4+) and induced sputum eosinophilia (>3%) as compared to those without AHR [72.2% vs. 39.5% and 66.7% vs. 31.6%]. The levels of nasal nitric oxide (1165.8 vs. 1043.7 ppb) and exhaled NO (FENO, 29.5 vs. 22.2 ppb) were significantly higher and closely associated in AHR patients. No significant difference in FEV1% presented between AHR and non-AHR groups, while significantly lower FEF25-75 (70.0% vs. 84.4%) was found in AHR group. Nasal volume and area reversibility to a-agonist were greater in AHR patients.

CONCLUSIONS:

Nasal and induced sputum eosinophilia and higher levels of nasal nitric oxide and FENO indicated AHR occurrence. Increases in reversibility to a-agonist in both nasal volume and nasal area of PER patients showed the presence of AHR. Moreover, FEF25-75 was useful for identifying AHR in PER patients.

CLINICAL IMPLICATIONS:

In summary, the measurements aforementioned may be helpful to identify AHR and early diagnosis of asthma in PER patients.DISCLOSURE: The following authors have nothing to disclose: Xiaofang Liu, Yongchang Sun, Luo ZhangNo Product/Research Disclosure InformationDepartment of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.

Recently, it has been reported that nasal cytology in light microscopy can identify biofilms, which appear as cyan-stained "Infectious Spots". We assessed by the same method and in the same population, the presence of biofilms in different nasal disorders, and estimated if a correlation with the functional grade of obstruction existed.Subjects suffering from different nasal disorders, after a detailed clinical history and ENT examination, underwent nasal fibroendoscopy, skin prick test, rhinomanometry and nasal cytology. The presence of biofilm was linked to the type ofdisease and to the grade of obstruction.Among 1,410 subjects previously studied, the infectious spot was found in 107 patients (7.6%), and this percentage reached 55.4% in subjects with cytologic signs of infectious rhinitis (presence of bacteria/fungi). Biofilms were largely more frequent in patients with adenoid hypertrophy (57.4%), followed by nasal polyposis (24%), chronic rhinosinusitis (9.5%) and non-allergic rhinitis (7.6%). Nasal cytology was normal in the remaining patients, where no infectious spot was detectable. Statistical analysis showed that nasal resistances were significantly higher in presence of biofilms in patients with adenoid hypertrophy (p = 0.003), nasal polyposis (p < 0.001), chronic rhinosinusitis (p = 0.018) and septal deviation (p = 0.001).The results demonstrate that biofilm is present not only in infectious rhinitis, but also in inflammatory and/or immune-mediated diseases. The presence of biofilms significantly correlates with the degree of nasal obstruction as assessed by rhinomanometry.

BACKGROUND AND OBJECTIVE:

Allergic rhinitis (AR) is common in asthmatic patients and may impair asthma control. However, this comorbidity is frequently missed. A simple test is needed to enable physicians to diagnose and evaluate the severity of both diseases. The SACRA (Self Assessment of Allergic Rhinitis and Asthma) Questionnaire, which GINA and ARIA Japan Committees developed in 2011, consist of questionnaires based on GINA and ARIA guidelines for the diagnosis and severity of AR and asthma, and a visual analog scale (VAS) to evaluate the severity of both diseases. Our objective was to investigate the clinical usefulness of SACRA as a patient-based screening tool for identifying asthmatic patients with AR.

METHODS:

SACRA, ACT (Asthma Control Test), and serum IgE RAST were performed in asthmatic patients. The correlation between SACRA and other parameters were analyzed.

RESULTS:

420 asthmatic patients were enrolled. Among 168 subjects who self-reported no concomitant AR, 76 asthmatics scored one or more symptoms on SACRA. Eventually, 32 of these 76 subjects were diagnosed with AR by physicians based on laboratory data or physical examinations by ENT specialists. The sensitivity and specificity of SACRA for the diagnosis of AR were 92% and 66% respectively. The estimated prevalence of AR among asthmatics was 66%, almost identical to that of the previous nationwide study in Japan. The level of asthma control assessed by the VAS on SACRA and the ACT score showed a strong correlation (r=-0.700, p <0.001).

CONCLUSIONS:

SACRA may be a clinically useful tool for identifying bronchial asthma patients with AR.

Migraine and allergic rhinitis (AR) are two common causes of headache and facial pain that inflammatory mediators with vasoactive function play important roles in both of them. The aim of this research was to determine the prevalence of migraine in AR patients.In a cross-sectional comparative study performed from June to December 2010 in patients with AR sign and symptoms referred to ear, nose, throat (ENT) clinic of a university hospital in Iran-Rasht, 46 patients with positive skin prick test were compared with 60 subject without AR signs and symptoms and with negative skin test. In both the groups, history of migraine according to IHS (International Headache Society ) criteria were investigated. Analysis of data was performed by chi-sqaure and Fisher exact test by using SPSS16. Odds ratio were estimated for determining the chance of migraine in AR.In case group (14 male, 37 female; mean age: 31.17 ± 8.31 years) and control group (23 male, 32 female; mean age: 37.58 ± 12.63 years), the prevalence of migraine was 37% and 5%, respectively. The differences in prevalence of migraine and migraine without aura between cases and controls were significant (P = 0.001). The chance of migraine in AR was 8.227 folds (95% CI: 2.38-28.42). In subjects older than 40 years old, the difference of prevalence of migraine was significant, contrary to subjects younger than 30 years old and between 30 and 39 years old.There is a correlation between migraine especially without aura and AR and this correlation is more powerful with increasing age.

OBJECTIVES

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HYPOTHESIS:

To investigate how quickly an allergic rhinitis (AR) patients' symptoms will improve with sublingual immunotherapy (SLIT).

STUDY DESIGN:

Double-blind placebo study.

METHODS:

This is a multicenter, randomized, double-blind, placebo-controlled study of SLIT used to treat house dust mite-induced AR. A total of 120 AR patients, aged 4 to 60 years, were treated for 6 months and randomized into two groups: 1) SLIT with Dermatophagoides pteronyssinus (D.p.) and Dermatophagoides farina (D.f.) extract (n = 60) ; and 2) matched placebo controls (n = 60). Symptom, medications received, and a visual analog scale score were recorded during the whole study. Serum-specific IgE and IgG4 to D. p. and D. f. were assessed before and after the treatment.

RESULTS:

Eighty-five patients (70.8%) completed the study. Twelve patients (20%) chose to withdraw from the SLIT group, but none because of serious adverse effects. The total symptom and visual analog scores VAS in the SLIT group decreased significantly when compared to the placebo controls (P <0.05) after week 14, as well as for the significant (P <0.05) improvement of all individual AR symptoms in the SLIT group (e.g., sneezing, nasal discharge, itching, and nasal obstruction) after week 22. There was a significant (P <0.05) increase of IgG4 to both D.f. and D.p. in the SLIT, but not in the placebo group after treatment.

CONCLUSION:

SLIT with a mixture of D.f. and D.p. extract is an effective and safe treatment for patients with house dust mite-induced AR. Its onset of action can be observed as early as 14 weeks after treatment.

LEVEL OF EVIDENCE:

1B. Laryngoscope, 2012.

Allergic rhinitis is the most common atopic disorder seen in ENT clinics. It is diagnosed by history, physical exam and objective testing. Patient education, environmental control measures, pharmacotherapy, and allergen-specific immunotherapy are the cornerstones of allergic rhinitis treatment and can significantly reduce the burden of disease. Current treatment guidelines include antihistamines, intranasal corticosteroids, oral and intranasal decongestants, intranasal anticholinergics, intranasal cromolyn, and leukotriene receptor antagonists. In the mechanism of allergic rhinitis, histamine is responsible for major allergic rhinitis symptoms such as rhinorrhea, nasal itching and sneezing. Its effect on nasal congestion is less evident. In contrast, leukotrienes result in increase in nasal airway resistance and vascular permeability. Antihistamines and leukotriene receptor antagonists are commonly used in the treatment of allergic rhinitis. The published literature about combined antihistamines and leukotriene antagonists in mono- or combination therapy is reviewed and presented.

Replication of reported associations is crucial to the investigation of complex disease. More than 100 SNPs have previously been reported as associated with allergic rhinitis (AR), but few of these have been replicated successfully. To investigate the general reproducibility of reported AR-associations in candidate gene studies, one Swedish (352 AR-cases, 709 controls) and one Singapore Chinese population (948 AR-cases, 580 controls) were analyzed using 49 AR-associated SNPs. The overall pattern of P-values indicated that very few of the investigated SNPs were associated with AR. Given published odds ratios (ORs) most SNPs showed high power to detect an association, but no correlations were found between the ORs of the two study populations or with published ORs. None of the association signals were in common to the two genome-wide association studies published in AR, indicating that the associations represent false positives or have much lower effect-sizes than reported.

Although CD23-dependent transcytosis of IgE and IgE-derived immune complexes across respiratory epithelial cells is likely to play a pivotal role in the initiation and development of airway allergic inflammation, there is currently a lack of physiological support for this phenomena to suggest that the targeting of CD23 could be used as a means of therapeutic intervention. The present study was designed to detect the CD23 expression in the nasal mucosa of allergic rhinitis (AR) murine model by immunohistochemistry and western blotting, and to investigate whether intranasal anti-CD23 treatment could inhibit allergen-induced upper airway inflammation in the AR model. This is the first report to show that CD23 was constitutively expressed in murine nasal epithelial cells, and its expression was significantly up-regulated in the AR murine model. In vivo, the up-regulation of CD23 expression was correlated with increased serum IL-4 levels. Following intranasal anti-CD23 treatment, nasal symptoms were alleviated and histopathologic examination showed a significant decrease in eosinophilic infiltration. Meanwhile, ELISA analysis showed levels of serum leukotriene C4 (LTC4), eosinophil cation protein (ECP), ovalbumin (OVA)-specific IgE and IL-4 also significantly decreased, as were LTC4 and OVA-specific IgE in the nasal lavage fluid. Furthermore, Western blotting analysis showed that ECP expression in the nasal mucosa was down-regulated. Finally, flow cytometric analysis revealed anti-CD23 treatment inhibited Th2 cell responses. These results indicate that intranasal anti-CD23 treatment can reduce allergic responses in a murine model of allergic rhinitis.

Allergen-specific immunotherapy is the only causative treatment of IgE-mediated allergic disorders. The most common administration route is subcutaneous, which may necessitate more than 50 allergen injections during 3 to 5 years. Recent evidence suggests that direct intralymphatic injections could yield faster beneficial results with considerably lower allergen doses and markedly reduced numbers of injections.To evaluate the effects of intralymphatic allergen-specific immunotherapy in pollen-allergic patients.In an open pilot investigation followed by a double-blind, placebo-controlled study, patients with allergic rhinitis were treated with 3 intralymphatic inguinal injections of ALK Alutard (containing 1000 SQ-U birch pollen or grass pollen) or placebo (ALK diluent). Clinical pre- and posttreatment parameters were assessed, the inflammatory cell content in nasal lavage fluids estimated, and the activation pattern of peripheral T cells described.All patients tolerated the intralymphatic immunotherapy (ILIT) treatment well, and the injections did not elicit any severe adverse event. Patients receiving active treatment displayed an initial increase in allergen-specific IgE level and peripheral T-cell activation. A clinical improvement in nasal allergic symptoms upon challenge was recorded along with a decreased inflammatory response in the nose. In addition, these patients reported an improvement in their seasonal allergic disease. No such changes were seen in the placebo group.Although this study is based on a limited number of patients, ILIT with grass-pollen or birch-pollen extracts appears to reduce nasal allergic symptoms without causing any safety problems. Hence, ILIT might constitute a less time-consuming and more cost-effective alternative to conventional subcutaneous allergen-specific immunotherapy.

Hypothyroidism is accepted as one of the hormonal factors leading to non-allergic rhinitis. Nasal obstruction and runny nose due to an increase in submucosal connective tissue and mucous gland hypertrophy are the prominent symptoms in hypothyroidism-induced rhinitis at humans. The aim of this study was to analyze the biochemical and histopathological changes in the nasal mucosa of the rats with thyroidectomy-induced hypothyroidism and to compare them with those of a control group.A total of 60 adult male Wistar Albino rats were included in the study. The rats constituting the test and the control groups were randomly divided into 3 subgroups (T1-3 and C 1-3). While the rats in the test group underwent thyroidectomy, in the control group the incision was sutured without any interventions after exposure of thyroid tissues of the rats. The nasal and paranasal sinus regions of all the rats were carefully dissected and tissue samples were obtained for pathological examinations.In the rats in T1, T2, and T3, the decrease in serum glucuronic acid levels before and after thyroidectomy was statistically significant (p = 0.001, p = 0.003, and p = 0.002, respectively). The difference between the test and the control groups was statistically significant in terms of inflammation at the end of 12 weeks (p = 0.002).An increase in acid mucopolysaccharidase production due to TSH has been suggested to cause congestion in tissues. Although our study supports the data in the literature up to date, we consider that further clinical and experimental studies are necessary for this verification.