Rhinitis

Comparison of clinical differences between patients with allergic rhinitis and nonallergic rhinitis

September 18, 2013     Mustafa Akarcay, MD; Murat C. Miman, MD; Tamer Erdem, MD; Semih Oncel, MD; Orhan Ozturan, MD; Erol Selimoglu, MD
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Abstract

We conducted a retrospective study to investigate the clinical differences between subtypes of rhinitis patients. Our findings were based on a detailed history and nasal examination. The study population was made up of 910 patients who had at least two rhinitis symptoms. These patients were categorized into one of three rhinitis groups: nonallergic rhinitis (NAR), seasonal allergic rhinitis (SAR), and perennial allergic rhinitis (PAR); there were 212 patients (23.3%) in the NAR group, 473 (52.0%) in the SAR group, and 225 (24.7%) in the PAR group. In addition to demographic data, we compiled information on the season when each patient presented, specific symptoms and their triggers, parental history, associated allergic diseases (e.g., skin, lung, and eye allergies), and nasal examination findings. The SAR patients represented the youngest of the three groups. Most SAR patients presented in spring and summer, and this group had the highest incidence of eye itchiness, pharyngeal itchiness, eye redness, and palatal itchiness. In terms of triggering factors, a visit to a green area was significantly more common in the SAR patients, while detergent odor, sudden temperature change, and cold air were significantly more common in the NAR patients. On nasal examination, a pale nasal mucosa was significantly more common in the NAR group. In clinical practice, it is crucial to differentiate between allergic and nonallergic rhinitis. We conclude that relevant information from the history can predict allergic rhinitis. Future studies of prevalence should take into consideration the important findings of our study, including the significance of age and the seasonality of exacerbation of rhinitis symptoms.

The impact of pulmonary tuberculosis treatment on the prevalence of allergic rhinitis

August 21, 2013     Carren Teh Sui Lin, MBBS, MS(ORL-HNS); Gopala Krishnan, MBBS, FRSC(Ed); and Anura Michelle Manuel, MBBS, MS(ORL-HNS)
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Abstract

Atopy is a syndrome characterized by immediate hypersensitivity reactions to common environmental antigens. The “hygiene hypothesis” stipulates that childhood infections are associated with a lower risk of allergies. Not much has been published about the effects that the treatment of pulmonary tuberculosis (TB) has on allergies, specifically allergic rhinitis. We conducted a study to investigate the prevalence of allergic rhinitis in patients with pulmonary TB before and after treatment of their TB. Our initial study group was made up of 121 patients with confirmed pulmonary TB who were followed up by questionnaire. In addition to demographic data, they provided information about their personal and family history of atopy and their current status with regard to allergic rhinitis. After providing informed consent, all patients underwent skin-prick testing with Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis allergens before and after TB treatment. Stool samples were obtained to identify patients with worm infestation, and they were excluded from the study. In all, 94 patients completed treatment and follow-up, and their data were included in the final analysis. Of this group, 31 patients (33.0%) exhibited symptoms of allergic rhinitis prior to TB treatment, and 26 (27.7%) had a positive skin-prick test. Following treatment, only 12 patients (12.8%) reported allergic rhinitis symptoms (p = 0.004), but there was no significant reduction in the number of patients with a positive skin-prick test (n = 20 [21.3%]; p = 0.555). We conclude that the treatment of pulmonary TB results in significant relief of atopy, particularly allergic rhinitis symptoms.

Traumatic unilateral vasomotor rhinitis

October 31, 2012     Evan J. Harlor, DO; J. Scott Greene, MD; Catherine Considine, DO
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Abstract

Vasomotor rhinitis (VMR) is a commonly encountered entity that may be difficult to diagnose. The classic symptoms are clear rhinorrhea and nasal congestion, commonly brought on by exercise, stress, heat, cold, and environmental irritants. The diagnosis is one of exclusion, and management usually involves avoidance of inciting agents and treatment with an anticholinergic nasal spray. We describe a case of VMR in a 22-year-old woman who presented with symptoms of clear, left-sided rhinorrhea and epiphora that had begun shortly after a motor vehicle accident approximately 1.5 years earlier, but which she had not reported at that time. The patient's left carotid canal had been fractured and the surrounding sympathetic plexus injured in the accident, resulting in an overactive parasympathetic system. Both exercise and heat exacerbated her symptoms. Allergy was excluded by negative allergy testing, and the patient did not respond to fluticasone nasal spray. Given the mechanism of injury, the unilaterality of symptoms, and the patient's lack of response to nasal steroids, it was thought that the VMR was due to the earlier traumatic injury, which had resulted in imbalance of the autonomic neural input. A trial of ipratropium was given to directly treat the parasympathetic overactivity. This treatment resulted in immediate improvement in both the nasal and lacrimal secretions.

Serum levels of advanced oxidation protein products in response to allergen exposure in allergic rhinitis

August 10, 2012     Fadlullah Aksoy, MD; Yavuz Selim Yıldırım, MD; Bayram Veyseller, MD; Hasan Demirhan, MD; Orhan Özturan, MD
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Abstract

Patients with asthma, allergic rhinitis, or atopic dermatitis experience increased oxidative stress. We conducted a prospective study to examine the levels of advanced oxidation protein products (AOPPs) as an indicator of oxidative stress in 97 patients with allergic rhinitis who were followed in our clinic during a 3.5-month period. Of these 97 patients, 51 were treated with subcutaneous immunotherapy (SCIT), and 46 did not receive any treatment until the study was concluded. In each patient, allergic rhinitis and allergic sensitization were documented by the history, the findings on clinical examination, and the results of blood and skin-prick tests. Blood samples from each patient were analyzed to determine AOPP levels. We found that the mean serum AOPP level was significantly higher in the SCIT group than in the non-SCIT group (258.55 vs. 163.83 µmol/L; p = 0.0015). We conclude that as a known indicator of protein oxidation, the serum AOPP level is a marker of increased oxidative stress in response to allergen exposure in allergic rhinitis.

Nasal eosinophilia as a marker for allergic rhinitis: A controlled study of 50 patients

March 1, 2012     Akefeh Ahmadiafshar, MD, Daryoosh Taghiloo, MD, Abdolreza Esmailzadeh, PhD, and Behnaz Falakaflaki, MD
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Abstract

Eosinophils are the principal effector cells involved in the pathogenesis of allergic inflammation. We conducted a study to investigate the validity of the nasal smear examination for detecting eosinophilia in patients with allergic rhinitis. Our study group was made up of 50 patients with allergic rhinitis and 50 age- and sex-matched controls without allergic rhinitis. Smears were obtained from nasal secretions in both groups and then fixed, stained, and studied under light microscopy. Statistical analysis revealed that the odds ratio for eosinophilia positivity in nasal smears in the rhinitis group was 25.61 with a 95% confidence interval of 8 to 78. The sensitivity, specificity, positive predictive value, and negative predictive value of this test were 74, 90, 88, and 77%, respectively. We conclude that the nasal eosinophilia test is highly specific and moderately sensitive in diagnosing allergic rhinitis, and that it therefore can be used as an easy, noninvasive, and inexpensive procedure for screening patients and for conducting epidemiologic studies of this disorder.

Additional information: This study was part of Dr. Taghiloo's graduate thesis, and it was supported by the Research Council of the Zanjan University of Medical Sciences.

Chronic rhinitis: A manifestation of leprosy

September 20, 2011     Ivan D. Camacho, MD, Anne Burdick, MD, MPH, Latanya Benjamin, MD, and Roy Casiano, MD
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Abstract

Leprosy, or Hansen disease, is an infection that affects the mucous membranes of the respiratory tract and may manifest with nasal symptoms of chronic rhinitis, including nasal congestion, rhinorrhea, and intermittent epistaxis. We present a case of a woman diagnosed with leprosy as an incidental finding from a biopsy obtained during endoscopic sinus surgery for the management of chronic rhinitis. The diagnosis of leprosy should be considered in patients with nasal symptoms and presumptive chronic rhinitis who do not respond adequately to standard therapies.

Invasive fungal rhinitis caused by Paecilomyces lilacinus infection: Report of a case and a novel treatment

December 17, 2010     Shawn C. Ciecko, MD and Richard Scher, MD
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Abstract

Invasive fungal infections of the sinonasal tract are a rare but known entity in immunocompromised patients. Paecilomyces lilacinus is a nematophagous fungi with septate hyphae that has afflicted humans in multiple forms, causing cutaneous, ocular, and sinonasal infections. Only 4 cases of P lilacinus and 2 cases of Paecilomyces variotii in the sinonasal tract have been reported in the literature. We present a case of invasive fungal rhinitis secondary to P lilacinus infection in an immunocompromised patient. She was managed successfully with a novel treatment: voriconazole and endonasal microdebridement.

Impaired mucociliary clearance in allergic rhinitis patients is related to a predisposition to rhinosinusitis

March 31, 2009     Ioannis Vlastos, MD, Ioannis Athanasopoulos, MD, PhD, Nicholas S. Mastronikolis, MD, PhD, Theodora Panogeorgou, MD, Vassilios Margaritis, MD, Stefanos Naxakis, MD, PhD, and Panos D. Goumas, MD
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Abstract

Although mucociliary clearance has been shown to be impaired in patients with allergic rhinitis and chronic rhinosinusitis, its exact role in relation to a predisposition to rhinosinusitis is unknown. To investigate this possible association, we conducted a prospective study of 125 patients with allergic rhinitis. Of this group, 23 patients were classified as being sinusitis-prone based on their history of antibiotic consumption for the treatment of rhinosinusitis; the remaining 102 patients were deemed to be not sinusitis-prone. The saccharine test was used to evaluate mucociliary clearance in all patients. Several variables-age, sex, smoking habits, rhinitis severity, and medication history-were examined. We found that the sinusitis-prone patients had a significantly greater mucociliary clearance time than did those who were not prone (median: 15 and 12 min, respectively; p = 0.02). No other statistically significant differences were seen between the 2 groups with respect to any other variables that might have affected mucociliary clearance. We conclude that impaired mucociliary clearance in allergic rhinitis patients is associated with a predisposition to rhinosinusitis.

Long-term immunotherapy for perennial allergic rhinitis: Relationship of specific IgG levels to skin-prick test results and clinical symptoms and signs

December 1, 2008     Rauf Tahamiler, MD, Salih Canakcioglu, MD, Suleyman Yilmaz, MD, and Huseyin Isildak, MD
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Abstract

We studied 63 adults with perennial allergic rhinitis and positive skin-prick tests for Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df) who had not previously received any type of immunotherapy or pharmacotherapy for their condition. We injected these patients with a 50% Dp/50% Df modified allergen intradermally in accordance with the classic immunotherapy scheme once a week for 30 months. Specific immunotherapy (SIT) was administered until the specific IgG (sIgG) concentration reached level IV (≥81% absorbance). We measured specific IgE and sIgG levels, obtained skin-prick test results, and evaluated clinical symptoms and signs before immunotherapy, at 6 months into therapy, at the completion of therapy (30 mo), and 1 year after the completion of therapy. In the group as a whole, differences between mean sIgG values and mean skin-prick test results before and after SIT were statistically significant (p < 0.05). At the 1-year follow-up, there was a negative correlation between sIgG levels and clinical symptom and sign scores, a positive correlation between skin-prick test results and clinical improvement, and a negative correlation between sIgG levels and skin-prick test results. Individually, at the 1-year follow-up, 50 of the 63 patients (79%) had experienced a resolution of clinical symptoms and/or signs and were thus deemed to have achieved clinical recovery.

Prevalence of autoimmune thyroid disease in chronic rhinitis

August 31, 2008     William R. Reisacher, MD, FACS, FAAOA
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Abstract

A retrospective, controlled study was undertaken to determine the prevalence of autoimmune thyroid disease in 111 adult patients with allergic (77) and nonallergic (34) rhinitis seen in a private ENT/allergy practice in the lower Hudson Valley, New York. The control group consisted of 101 patients with no history of chronic rhinitis. Autoimmune thyroid disease was found in 10.4% of the allergic rhinitis group, 14.7% of the nonallergic rhinitis group, and 9.9% of controls, with a trend toward higher prevalence in the nonallergic rhinitis group compared with controls. No statistically significant association was noted between the 3 groups. The female-to-male ratio in the nonallergic rhinitis group was approximately twice as high as in the control group.

Onset of action of ciclesonide once daily in the treatment of seasonal allergic rhinitis

May 31, 2008     Piyush Patel, MD, Deepen Patel, MD, Sudeesha Kunjibettu, PhD, Nancy Hall, MS, and Mark A. Wingertzahn, PhD
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Abstract

Ciclesonide is an intranasal corticosteroid approved for the treatment of allergic rhinitis. We conducted a randomized, double-blind, parallel-group, placebo-controlled study to evaluate the time to onset of action of ciclesonide 200 μg once daily in 502 adults with seasonal allergic rhinitis of at least 2 years' duration. To trigger immunologic priming, patients underwent between one and five priming sessions with exposure to 3,500 grains/m3 (±500) of ragweed pollen in an environmental exposure chamber. The criteria for a successful priming session were a patient-assessed instantaneous total nasal symptom score of at least 6 (of a possible 12) and a nasal congestion or rhinorrhea score of at least 2 (of a possible 3) 90 minutes after allergen exposure during at least two consecutive priming sessions. Patients were then randomly assigned to receive either a single dose of ciclesonide 200 μg (n = 251) or placebo (n = 251) administered intranasally. The difference in the change from baseline total nasal symptom scores in the two groups was assessed hourly for 12 hours after administration. Onset of action was determined to have taken place the first time that the effects of ciclesonide, as reflected in the total nasal symptom score, were significantly greater than those of placebo at a particular hourly assessment, provided that the subsequent hourly assessment also showed a statistically significant difference. The onset of action of ciclesonide occurred within 1 hour of administration (p = 0.01 vs. placebo), and the significant difference in total nasal symptom scores between ciclesonide and placebo was maintained through post-treatment hour 12 (p = 0.018).

Nodular fasciitis of the nasal cavity: A case report

December 1, 2007     David Mullin, MD, Fred W. Lindsay, DO, and Michael A. Keefe, MD
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Abstract

Nodular fasciitis is an uncommon tumor-like fibroblastic proliferation of the head and neck that is difficult to differentiate from its more malignant counterparts. Despite modern advances, making this distinction is challenging because the clinical presentation is nonspecific and the histologic and radiologic features are variable. Once nodular fasciitis is diagnosed, the primary treatment is conservative resection and observation. We describe a case of nodular fasciitis of the nasal cavity in a 43-year-old woman. To the best of our knowledge, this is only the second reported case of nodular fasciitis arising in the nasal cavity, and the first such case in an adult.

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