Minimal persistent inflammation in allergic rhinitis: implications for current treatment strategies

Abstract

SummaryPatients with allergic rhinitis have traditionally been placed into 'seasonal' and 'perennial' categories, which do not account for the subclinical inflammatory state that exists in many patients. In subjects with seasonal and perennial allergic rhinitis, even subthreshold doses of allergen have been found to cause inflammatory cell infiltration in the nasal mucosa, including increases in expression of cellular adhesion molecules, nasal and conjunctival eosinophilia, and other markers of inflammation, which do not result in overt allergy symptoms. This state -which has been termed 'minimal persistent inflammation' -may contribute to hyperreactivity and increased susceptibility to development of clinical symptoms as well as common co-morbidities of allergic rhinitis, such as asthma. Treating overt allergy symptoms as well as this underlying inflammatory state requires agents that have well-established clinical efficacy, convenient administration, potent anti-inflammatory effects and proven long-term safety, so that long-term continuous administration is feasible. Of the three major classes of commonly used allergic rhinitis medications -intranasal corticosteroids, anti-histamines, and anti-leukotrienesintranasal corticosteroids appear to represent the most reasonable therapeutic option in patients who would benefit from continuous inhibition of persistent inflammation.

Cysteinyl leukotriene levels correlate with 8-isoprostane levels in exhaled breath condensates of atopic and healthy children

“…Possible reasons for similar EBC cysteinyl leukotriene levels observed in the asthmatic and healthy children in this study include a mild and intermittent severity of asthma among affected children and the exposure of healthy children to environmental pollutants that may cause mild, persistent airway inflammation and higher concentrations of cysteinyl leukotriene in the EBCs (27)(28)(29). In agreement with the results of an Italian study (21), the EBCs of children with asthma and allergic rhinitis had higher cysteinyl leukotriene concentrations compared with the EBCs of healthy children.…”

The use of intranasal glucocorticosteroids in the treatment of rhinosinusitis: Focus on mometasone furoate

“…При остром, рецидивирующем и хроническом РС доказана эффективность применения инГКС как в виде монотера-пии, так и в качестве дополнения к антибиотикам [11,13]. Кроме того, инГКС оказывают доказанный терапевтиче-ский эффект при аллергическом рините, являющемся од-ним из основных факторов риска развития РС, в том чис-ле за счет подавления характерного для данного заболева-ния «минимального персистирующего воспаления», ко-торое способствует возникновению назальной гиперреак-тивности и предрасполагает к развитию коморбидности [50].…”

Cytokine Contents in Nasal Secretions of Children With Combined Forms of Respiratory Pollen Allergy Before and After Three Courses of Sublingual Allergen-Specific Immunotherapy

“…Изучались иммунные изменения, про-исходящие на различных стадиях аллергического процесса [2, 3,4,5,6,7,8,9,10,11,12,13,14,15], выявлено наличие персистирующего воспаления, даже при отсутствии клинических симптомов в периоде ремиссии АЗ [2, 4,14,16]. Исследова-лись иммунологические реакции, происходящие при различных способах лечебного воздействия [1, 2, 8, 9, 17, 18], в том числе при подкожной [19] и сублингвальной [1,17] аллергенспецифической иммунотерапии как наиболее эффективном па-тогенетическом методе лечения АЗ.…”