Clinical Efficacy of Nasal Steroids on Nonallergic Rhinitis and the Associated Inflammatory Cell Phenotypes

Kirtsreesakul,; Hararuk, K; Leelapong, Jitanong; Ruttanaphol, Suwalee

doi:10.2500/ajra.2015.29.4234

Cited by 25 publications

(26 citation statements)

References 28 publications

(28 reference statements)

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“…The time taken to detect the charcoal‐like appearance was noted as the NMCCT. The test was performed in the left and right sides of the nasal cavity, and the average of the two values was taken as the NMCCT for each subject …”

Section: Methodsmentioning

confidence: 99%

Correlation Between Peak Nasal Flow Reversibility and Mucociliary Clearance in Allergic Rhinitis

2019

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Objectives/Hypothesis: Reversibility of nasal airflow after decongestion measured by rhinomanometry is associated with the severity of allergic inflammation. Peak nasal flow is a simpler alternative method for assessing nasal patency. The aim of this study was to evaluate the correlation between changes in peak nasal expiratory and inspiratory flows (PNEFs and PNIFs) after decongestion and nasal mucociliary clearance times (NMCCTs).Study Design: Single-center, prospective cross-sectional study. Methods: One hundred one allergic rhinitis patients were enrolled. Nasal symptoms and NMCCTs were assessed. PNEF and PNIF were performed before and after decongestion. Correlations between changes in PNEF and PNIF after decongestion and NMCCTs were analyzed. One-half the standard deviation of baseline peak nasal flows was used to estimate the minimal clinically important differences (MCIDs) and discriminate between patients with reversible mucosa and with irreversible mucosa.Results: PNEF showed more peak flow improvements after decongestion compared to PNIF. Changes in PNEF had better negative correlations with NMCCTs than PNIF (ρ = −0.49, P < .001 and ρ = −0.34, P < .001, respectively). The MCID values of the PNEF and PNIF were 27.93 and 19.74, respectively. In comparisons of NMCCTs between patients with or without MCID of peak nasal flow after decongestion, PNEF had better discrimination ability compared to PNIF (P = .003 and P = .026, respectively).Conclusions: The limitation of reversibility as measured by peak nasal flows could indirectly point to the affection of mucosal inflammation as indicated by NMCCTs. PNEF is more sensitive to assess peak flow changes after decongestion than PNIF.

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Section: Methodsmentioning

confidence: 99%

Correlation Between Peak Nasal Flow Reversibility and Mucociliary Clearance in Allergic Rhinitis

2019

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“…Therefore, we strongly suggest defining the different phenotypes of NAR, and in particular the presence of nasal eosinophilia, which causes the most severe symptoms and greater association with comorbidities . Corticosteroids are effective in controlling nasal symptoms in these patients by directly inducing eosinophil apoptosis, inhibiting eosinophil recruitment and its migration into the nasal airways . Nevertheless, the long‐term usage of corticosteroids is limited in certain situations such us hemorrhagic diatheses, history of recurrent nasal bleeding, and ocular contraindications; for these, alternative therapeutical options may be useful.…”

Section: Introductionmentioning

confidence: 99%

Antileukotrienes improve naso‐ocular symptoms and biomarkers in patients with NARES and asthma

et al. 2018

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Objective The aim of our study was to analyze the montelukast effectiveness in improving oculonasal symptoms, patient‐reported outcomes (PROs), and eosinophilic biomarkers in patients with nonallergic rhinitis eosinophilic syndrome (NARES). Methods We enrolled prospectively 80 symptomatic patients treated with 10 mg once a day of montelukast in monotherapy for 2 months. All patients were investigated before and after treatment. Nasal symptoms (nasal obstruction, rhinorrhoea, sneezing, nasal itching), ocular symptoms (redness/puffiness, watery eyes), and other PROs (olfactory dysfunction, difficulty going to sleep, nighttime awakenings, and nasal congestion on awakening) were scored by visual analogic scale. The following clinical scores were assessed: Total Nasal Symptom Score (T4NSS), Total Ocular Symptom Score (T2OSS), Total Symptom Score of Patient‐Reported Outcomes (TSS‐PROs), and a Composite Symptoms Score (CSS). Patients were classified as responders when a reduction of at least 50% of the CSS was observed. Before and after treatment, the eosinophilic biomarkers in nasal lavage were analyzed: nasal eosinophilia (number of eosinophils per high power field), eotaxin‐1 and eotaxin‐2. Results After treatment, significant reductions were observed for all the symptom scores. Forty‐two of 78 patients were considered responders. A significant reduction of eosinophils in nasal mucosa and of levels of eotaxin‐1 and eotaxin‐2 in nasal lavage were observed after treatment in responder patients. Patients with asthma had an increased probability to be responders. Conclusion NARES patients may benefit from treatment with montelukast. In particular, the presence of concomitant asthma may be predictive of a greater efficacy. Level of Evidence 2 Laryngoscope, 129:551–557, 2019

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“…The response rate for primary radiofrequency turbinate surgery was 68.6%, with significant improvement of rhinorrhea and nasal obstruction and no major complications. 15 Kirtsreesakul et al 16 evaluated the efficacy of intranasal steroids in 82 patients with AR and 67 patients without AR. 16 The non-AR group was divided into inflammatory non-AR and noninflammatory non-AR groups.…”

Section: T His Issue Of American Journal Of Rhinology Andmentioning

confidence: 99%

“…15 Kirtsreesakul et al 16 evaluated the efficacy of intranasal steroids in 82 patients with AR and 67 patients without AR. 16 The non-AR group was divided into inflammatory non-AR and noninflammatory non-AR groups. The inflammatory non-AR group was subdivided into four phenotypes according to inflammatory-cell type.…”

Section: T His Issue Of American Journal Of Rhinology Andmentioning

confidence: 99%

“…Among patients in the non-AR group, noninflammatory cases had the worst treatment outcomes. 16 Indolamine-2,3-dioxygenase is a metabolic enzyme induced by immune activation. Refaat et al 17 found a significant increase in indolamine-2,3-dioxygenase levels in allergic rhinitis compared with subjects without allergy.…”

Section: T His Issue Of American Journal Of Rhinology Andmentioning

confidence: 99%

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Editorial: Inflammatory and Allergic Diseases of the Upper Airways

Mahdavinia¹

2015

Am J Rhinol�Allergy

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Editorial: Inflammatory and allergic diseases of the upper airways T his issue of American Journal of Rhinology and Allergy (AJRA) covers a diverse selection of articles on basic and clinical aspects of inflammatory diseases of the upper airways. One such disease, chronic rhinosinusitis (CRS), significantly lowers quality of life. Despite recent progress, however, CRS remains poorly understood. A few of the articles in this AJRA issue focus on the pathophysiology of CRS.The literature indicates a role for prostaglandin-E2 and E-prostanoid (EP) receptors in CRS. When comparing EP receptors in CRS subtypes, Xie et al. 1 found enhanced EP1 receptor messenger RNA (mRNA) and protein expression in eosinophilic CRS with nasal polyps (CRSwNP). However, EP4 mRNA levels were higher than EP1, EP2, and EP3 levels in controls; in CRS without nasal polyps (CRSsNP); and in noneosinophilic CRSwNP. 1 Nasal tissue eosinophilia is a hallmark of CRSwNP, especially in patients from Western countries. Results of studies have shown an association between tissue eosinophilia and polyp recurrence. In their retrospective analysis from China of 387 patients with CRSwNP, Lou et al. 2 found a significant correlation between tissue eosinophilia and polyp recurrence. They showed that tissue eosinophils Ͼ27% of total cells or a tissue eosinophil absolute count of Ն55 eosinophils per high power field is a reliable prognostic indicator for nasal polyp recurrence within 2 years after surgery. 2 CRS has been linked to imbalances in the production of eicosanoids (arachidonic acid metabolites), which results from phospholipid hydrolysis by phospholipase A2 (PLA2). Mruwat et al. 3 investigated the expression of PLA2s and multiple cytokines in super-antigen Staphylococcus aureus enterotoxin stimulated human nasal polyps from patients with CRSwNP. Stimulation of nasal polyp cells by S. aureus enterotoxin induced cytokine secretion and enhanced expression of several secretory PLA2 and calciumindependent PLA2, while suppressing cytoplasmic PLA2 expression. This supports a role for secretory PLA2s in the pathophysiology of CRS. 3 Wang et al. 4 evaluated the ethmoid bone tissue samples from a group of patients with CRS by histologic examination and quantitative real-time reverse transcription polymerase chain reaction and showed an increased infiltration of eosinophils in the periosteum, along with neo-osteogenesis in CRS. The investigators found increased expression of TGF-␤1, TGF-␤ receptor I, and p-Smad3 in patients with CRSwNP compared with CRSsNP at the mRNA and protein levels. The investigators concluded that these findings were indicative of a potential role for eosinophils in the bone remodeling process in CRSwNP. 4 Oral steroids are used routinely in the management of CRS. However, providers should be aware of potential adverse effects and complications with these medications. In this issue of AJRA, Poetker 5 comprehensively reviews existing data on the risks of oral steroids and discusses the use of oral steroids in CRS.With the recent emergence o...

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Clinical Efficacy of Nasal Steroids on Nonallergic Rhinitis and the Associated Inflammatory Cell Phenotypes

Abstract: Although both patients with non-AR and those with AR had good steroid response, the patients with non-AR had less improvement than the patients with AR. Patients with NINAR had the worst treatment outcome among the non-AR phenotypes.

Cited by 25 publications

References 28 publications

Correlation Between Peak Nasal Flow Reversibility and Mucociliary Clearance in Allergic Rhinitis

Correlation Between Peak Nasal Flow Reversibility and Mucociliary Clearance in Allergic Rhinitis

Antileukotrienes improve naso‐ocular symptoms and biomarkers in patients with NARES and asthma

Editorial: Inflammatory and Allergic Diseases of the Upper Airways

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