Exhaled and nasal NO levels in allergic rhinitis: relation to sensitization, pollen season and bronchial hyperresponsiveness

Henriksen, Anne Hildur; Sue‐Chu, Malcolm; Holmen, Turid Lingaas; Langhammer, Arnulf; Bjermer, Leif

doi:10.1034/j.1399-3003.1999.13b14.x

Cited by 188 publications

(182 citation statements)

References 21 publications

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“…In allergic rhinitis the picture is less clear. Some groups have shown an increase in nasal NO in rhinitis [26][27][28], while others find normal values in these patients [24,29,30]. The reason for the discrepancies in studies on rhinitis is probably related to methodology.…”

Section: Discussionmentioning

confidence: 98%

Assessment of nasal and sinus nitric oxide output using single-breath humming exhalations

Maniscalco¹,

Weitzberg²,

Sundberg³

et al. 2003

European Respiratory Journal

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Nasal nitric oxide (NO) levels increase greatly during humming compared to silent exhalation. In this study, the physiological and anatomical factors that regulate NO release during humming have been characterised in 10 healthy subjects and in a model of the sinus and the nose.Single-breath humming caused a large initial peak in nasal NO output, followed by a progressive decline. The NO peak decreased in a step-wise manner during repeated consecutive humming manoeuvres but recovered completely after a silent period of 3 min. Topical nasal application of an NO synthase inhibitor reduced nasal NO by w50% but had no effect on the increase evoked by humming. Silently exhaled nasal NO measured immediately after repeated humming manoeuvres was between 5-50% lower than basal silent NO exhalation, suggesting variable continuous contribution from the sinuses to nasal NO. Among the factors known to influence normal sinus ventilation, ostium size was the most critical during humming, but humming frequency was also of importance.In conclusion, humming results in a large increase in nasal nitric oxide, which is caused by a rapid gas exchange in the paranasal sinuses. Combined nasal nitric oxide measurement with and without humming could be of use to estimate sinus ventilation and to better separate nasal mucosal nitric oxide output from sinus nitric oxide in health and disease. Eur Respir J 2003; 22: 323-329. This study was supported by a grant from the Swedish Heart-Lung Foundation, the Swedish Research Council and by a grant from University Federico II "Progetto scambi internazionali".Nitric oxide (NO) is released into the airway lumen [1], in particular in the upper airways [2][3][4]. The exact origin of NO found in nasal air and the relative contribution from different sources within the nasal airways are not known. The paranasal sinuses are major sources of NO in adult healthy subjects [5] and the concentrations in a healthy sinus may be very high, ranging 5-20 parts per million (ppm) [5]. The sinuses communicate with the nasal cavity through the ostia and the rate of gas exchange between these cavities is dependent on several factors, such as the size of the ostia, the volume of the sinus, the nasal airflow and intra-nasal pressure [6,7]. Proper ventilation is essential for maintenance of sinus integrity, and blockage of the ostium is a central event in the pathogenesis of sinusitis [8,9]. During normal ventilation, the time required to exchange all air in the sinuses is y30 min, with large inter-individual variation [7,10]. Sinus ventilation is much slower in patients with sinus disorders [10].Recently, the current authors have shown that nasal NO levels increase greatly during humming compared to normal silent nasal exhalation, probably by speeding up the sinus gas exchange, thereby increasing nasal NO output [11]. In a twocompartment model of the nose and sinus the authors demonstrated that pulsating airflow, created by humming, causes a dramatic increase in gas exchange between these cavities [11].In the ...

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Section: Discussionmentioning

confidence: 98%

Assessment of nasal and sinus nitric oxide output using single-breath humming exhalations

Maniscalco¹,

Weitzberg²,

Sundberg³

et al. 2003

European Respiratory Journal

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“…This may indicate that air speed will have to be taken into consideration in future nasal NO measurements and that different methods at different volume flow rates measure different aspects of nasal NO release. Interestingly, two studies on allergic rhinitis show an increase in nasal NO [6,27], while two show no difference in nasal NO [7,12].…”

Section: Discussionmentioning

confidence: 99%

Characterization of exhaled nitric oxide: introducing a new reproducible method for nasal nitric oxide measurements

Palm¹,

Gräf

Lundberg³

et al. 2000

Eur Respir J

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Nitric oxide (NO) is present in the human nasal airways and has been suggested to originate primarily from the paranasal sinuses. The aim of this study was to establish a new and reproducible method for measurement of nasal NO.Through repeated single-breath measurements the intra-and inter-individual variations of NO levels in nasally (into a tightly fitting mask covering the nose) and orally exhaled air were determined in healthy humans. Variations due to the methods used were investigated. The contribution of oral NO to the nasal exhalations by introducing a mouthwash procedure was also studied.This study shows distinct individual values of NO in nasally and orally exhaled air of healthy humans. Some diurnal variability was also found with a rise in NO in nasally and orally exhaled air over the day, but no, or little, day-to-day variability when comparing the results from separate mornings. There was no correlation between NO levels in nasally and orally exhaled air, whereas there was a strong correlation between NO levels in air exhaled through the left and right nostril. The levels of NO in air exhaled at 0.17 L . s -1 through either nostril separately were higher than in air exhaled at the same flow rate through both nostrils simultaneously. After the introduction of a mouthwash procedure the level of NO in orally, but not nasally exhaled air was reduced.To conclude the method using nasal exhalation into a nose mask is highly reproducible. It is also suggested that subtracting the level of NO in orally exhaled air, after mouthwash, from that in nasally exhaled air, would adequately reflect nasal NO levels. Eur Respir J 2000; 16: 236±241.

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“…These atopic subjects with rhinitis had probably progressed to a state of symptomatic allergy. This beginning stage of airway inflammation is manifested by increased bronchial hyper-reactivity [8,34,35], which has previously been related to rhinitis [36]. Consequently, such subjects have a high risk of developing asthma [37].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, it has been suggested that atopy affects eNO concentration in asthmatic children as atopic asthmatic children have been reported to have significantly higher eNO levels than nonatopic asthmatics [7]. Furthermore, eNO has been shown to be elevated among non-asthmatic adults in concomitance with allergic rhinitis [8]. The aim of this study was to determine how allergic sensitization (as assessed by skin prick test (SPT) positivity to common allergens) and rhinitis modulate the relationship between eNO and asthma.…”

Section: Introductionmentioning

confidence: 99%

Interrelationships among asthma, atopy, rhinitis and exhaled nitric oxide in a population‐based sample of children

Jouaville¹,

Annesi‐Maesano

Nguyễn³

et al. 2003

Clin Experimental Allergy

116

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SummaryBackground Exhaled nitric oxide (eNO) has attracted increasing interest as a non-invasive marker of airway inflammation in asthma. However, little evidence exists on the influences exerted on eNO by the interrelations among atopic status, asthma and rhinitis. Methods Among the 1156 children who participated in a large-scale epidemiological survey on asthma and allergies (ISAAC II: International Study of Asthma and Allergies in Childhood Phase II) in the city of Clermont-Ferrand, 53 asthmatics without corticosteroid treatment and 96 nonasthmatics were invited to perform eNO and skin prick tests (SPTs) to 12 common allergens. Results Atopic asthmatic children had higher eNO than non-atopic asthmatic children (28.979.1 vs. 17.1713.1 p.p.b.; P 5 0.0004) with a significant increase when one SPT or more are positive (26.577.8 vs. 17.1713.1 p.p.b.; P 5 0.03). Similarly, non-asthmatic, atopic subjects had higher eNO than non-atopic subjects with a significant increase when two SPTs or more are positive (19.479.8 vs. 11.7 76.7 p.p.b.; P 5 0.003). In the case of equal levels of positive SPTs (0, 1, X2), asthmatic children always had higher eNO than non-asthmatic ones. Furthermore, among non-asthmatic children, the eNO level increased only in atopics who had rhinitis (20.7713 vs. 12.576.4 p.p.b. in atopic controls (subjects without rhinitis and asthma) and 12.376.6 p.p.b. in non-atopic controls; P 5 0.001), whereas among asthmatic children, eNO level increased in atopics independently of rhinitis (28.279.5 p.p.b. in those with rhinitis and 30.978.1 p.p.b. in those without) as well as in nonatopics with rhinitis (22.5717.2 p.p.b.). Conclusions Our data suggest that besides atopy and asthma, allergic rhinitis should also be taken into account in the assessment of eNO.

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Exhaled and nasal NO levels in allergic rhinitis: relation to sensitization, pollen season and bronchial hyperresponsiveness

Cited by 188 publications

References 21 publications

Assessment of nasal and sinus nitric oxide output using single-breath humming exhalations

Assessment of nasal and sinus nitric oxide output using single-breath humming exhalations

Characterization of exhaled nitric oxide: introducing a new reproducible method for nasal nitric oxide measurements

Interrelationships among asthma, atopy, rhinitis and exhaled nitric oxide in a population‐based sample of children

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