Nasal nitric oxide in allergic rhinitis in children and its relationship to severity and treatment

Wang, Pengpeng; Wang, Guixiang; Ge, Wentong; Tang, Lei; Zhang, Jie; Ni, Xin

doi:10.1186/s13223-017-0191-z

Cited by 23 publications

(22 citation statements)

References 16 publications

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“…This 50-year age span may have caused its correlation with NO. The correlation between the NO level and nasal symptoms has been evaluated in previous studies, both in adults and in children 55. However, the correlations were weak for all the typical symptoms of AR.…”

Section: Discussionmentioning

confidence: 94%

Nasal Nitric Oxide Is Correlated With Nasal Patency and Nasal Symptoms

Ren

Zhang

et al. 2019

Allergy Asthma Immunol Res

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Purpose Nitric oxide (NO) is an important endogenous mediator in both upper and lower respiratory systems. The purpose of the present study was to extract nasal NO (nNO) normal range of Chinese adults and the internal influencing factors. The differences in nNO levels between rhinitis and asymptomatic atopic subjects, and the diagnostic value of nNO in allergic rhinitis (AR) were further investigated. Methods One thousand adults were recruited from the general public. Participants were divided into different subgroups according to the questionnaires and skin prick tests. In all of these subjects, nNO, fractional exhaled NO (FeNO) and nasal airflow resistance were measured. The normal ranges of nNO and FeNO, the differences between subgroups, and the correlations between NO (nNO and FeNO) and other internal factors were analyzed. Results Both nNO and FeNO levels were significantly higher in AR patients than in healthy and asymptomatic atopic subjects. The nNO levels were significantly lower in asymptomatic atopic subjects than in normal adults. FeNO levels were significantly higher in non-AR patients than in the healthy and asymptomatic atopic adults. The cutoff value of nNO for the diagnosis of AR was 117.5 ppb (sensitivity, 50.9%; specificity, 63.9%). The nNO levels were correlated with FeNO levels, total nasal resistance measured at 75Pa, nasal volume within 0–7 cm from the anterior nares (V 0–7cm ) and nasal symptom visual analogue scale (VAS) scores, while the FeNO levels were correlated with age, height, weight, body surface area, nasal volume of V 0–7cm and the nasal symptom VAS score. Conclusions The nNO level can be significantly different between healthy and AR patients and may be significantly correlated with nasal symptoms and nasal patency of rhinitis patients. However, the clinical value of nNO is still in the exploration stage.

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Section: Discussionmentioning

confidence: 94%

Nasal Nitric Oxide Is Correlated With Nasal Patency and Nasal Symptoms

Ren

Zhang

et al. 2019

Allergy Asthma Immunol Res

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“…Measurements of nNO are completely noninvasive and can easily be performed in children 11 . nNO measurements may be a useful marker for evaluating nasal inflammation in allergic rhinitis (AR) patients, 12 . nNO production is triggered mainly by airborne allergens in combination with iNOS induction, and AR patients tend to show significant nNO levels 13, 14.…”

Section: Introductionmentioning

confidence: 99%

Nasal nitric oxide is a useful biomarker for acute unilateral maxillary sinusitis in pediatric allergic rhinitis: A prospective observational cohort study

Wen

Lin

Yang

et al. 2019

World Allergy Organization Journal

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Background Nasal nitric oxide (nNO) could be a biomarker for nasal passage inflammation and sinus ostial patency. We have aimed to investigate the nNO concentration and the effect of antibiotic therapy in children with perennial allergic rhinitis (PAR) children with/without acute bacterial sinusitis. Methods We enrolled a cohort of 90 and 31 children with PAR, without and with acute unilateral maxillary sinusitis, and 79 normal children. Acute bacterial maxillary sinusitis was diagnosed based on clinical signs and symptoms, radiographic examination and nasal fibroendoscopy. Rhinitis control assessment test (RCAT), rhinomanometry, nNO and fractional exhaled NO (FENO) measurements were performed before and 2 weeks after antibiotic therapy. Results We found significantly higher mean nNO levels, FENO values, and total nasal resistance in children with PAR than in normal children ( p < 0.05). Acute unilateral maxillary sinusitis was associated with lower lesion-side nNO levels, higher FENO values, total nasal resistance, and poor RCAT scores ( p < 0.05). In multivariate analysis, age, IgE, and acute maxillary sinusitis were significant factors influencing nNO levels in children with PAR. The lesion-side nNO levels, FENO values, total nasal resistance, and RCAT scores were reversed after antibiotic therapy ( p < 0.05). The lesion-side nNO levels were significantly correlated to nasal obstructive scores ( r = 0.59, p < 0.05) and expiratory nasal resistance ( r = −0.54, p < 0.05) in the acute maxillary sinusitis. A cut-off nNO value of 538 ppb showed 100% sensitivity and 94.9% specificity, to predict PAR from normal children. An nNO value of 462 ppb showed 100% sensitivity and 100% specificity to discriminate between the lesion-side and the unaffected sinus-side in PAR children with acute unilateral maxillary sinusitis. Conclusions We conclude that the obstruction of NO from the sinus into the nasal passage is the likely explanation for the decreased lesion-side nNO levels in acute unilateral maxillary sinusitis. nNO is a non-invasive biomarker with high sensitivity to diagnose and monitor treatment responses of PAR patients with acute rhinosinusitis. Both nNO and FENO levels return to baseline following antibiotic therapy, supporting the “one airway one disease” concept.

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“… 13 However, the debate on the utility of nFeNO in allergic diseases is still open, especially for the presence of different and not standardized methods of measurement, which causes difficulties in comparing studies among each other. 16 …”

Section: Discussionmentioning

confidence: 99%

The Role of Nasal Nitric Oxide and Anterior Active Rhinomanometry in the Diagnosis of Allergic Rhinitis and Asthma: A Message for Pediatric Clinical Practice

Brindisi¹,

Vittori²,

Nola³

et al. 2021

JAA

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Background Allergic rhinitis (AR) and asthma are two common atopic diseases, often associated with a common ethiopathogenesis characterized by a Th2 inflammatory response with the release of many biomarkers, such as nitric oxide (NO). Purpose To evaluate and compare inflammatory (nFeNO and eFeNO) and functional (mNF and FEV1) parameters in AR children with or without asthma in comparison to controls. Secondly, we aimed to identify nFeNO cut-off values and verify their reliability to predict the presence of rhinitis or asthma alone or in combination. Patients and Methods We enrolled 160 children (6–12 years of age) with AR and/or asthma divided into four groups: controls, AR, asthma, and AR + asthma. All children underwent the following inflammatory and functional measurements: nFeNO, eFeNO, mNF and FEV1. Results We observed that levels of nFeNO were extremely higher in children with AR and even more in those with AR + asthma in respect to controls. Notably, all the pathological conditions, especially AR + asthma, showed significantly lower values of mNF compared to healthy children. A negative correlation linked mNF and nFeNO. Then, we found eFeNO values significantly higher in all the pathological groups compared to controls, with major values of this marker in patients affected by asthma and AR + asthma, as well as FEV1 values significantly lower in all the disease groups, especially in children with asthma and AR+ asthma. ROC curve analysis showed that nFeNO was a great predictor for rhinitis alone or with asthma, revealing an accurate cut-off of 662 ppb. Conclusion nFeNO measurement is non-invasive, easy to perform, economic and a valuable test in case of AR alone or in association with asthma. Thus, it should be used in patients with rhinitis, together with anterior active rhinomanometry (AAR) to diagnose and estimate the degree of nasal obstruction but also in children with asthma to assess their nasal involvement and improve the therapeutic management.

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Nasal nitric oxide in allergic rhinitis in children and its relationship to severity and treatment

Cited by 23 publications

References 16 publications

Nasal Nitric Oxide Is Correlated With Nasal Patency and Nasal Symptoms

Nasal Nitric Oxide Is Correlated With Nasal Patency and Nasal Symptoms

Nasal nitric oxide is a useful biomarker for acute unilateral maxillary sinusitis in pediatric allergic rhinitis: A prospective observational cohort study

The Role of Nasal Nitric Oxide and Anterior Active Rhinomanometry in the Diagnosis of Allergic Rhinitis and Asthma: A Message for Pediatric Clinical Practice

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