Nasal polyps: Effects of seasonal allergen exposure

Keith, Paul K.; Conway, Mary E.; Evans, S. A.; Wong, Dennis A.; Jordana, Gloria; Pengelly, David; Dolovich, J.

doi:10.1016/s0091-6749(94)70068-0

Cited by 78 publications

(51 citation statements)

References 19 publications

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“…Pearlman et al 887 found no significant difference in atopic rates between CRSwNP and CRSsNP groups. Keith et al 888 found that ragweed-allergic CRSwNP patients did not have worse symptoms during the ragweed season. Erbek et al 889 divided patients with CRSwNP by atopic status.…”

Section: Viiib Crswnp: Comorbid Asthmamentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

554

888

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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Section: Viiib Crswnp: Comorbid Asthmamentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

554

888

View full text Add to dashboard Cite

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“…Nasal mucosa infiltration by numerous eosinophils and mast cells is the most characteristic feature of nasal polyposis (17). Higher ECP and eosinophil counts were noted in patients with polyposis, suggesting that an excessive response by activated eosinophils may induce a more profound inflammatory process of the nasal polyp (18). Mast cells act as a key effector in allergic reactions with an ability to release both tryptase and cytokines in response to allergen (19).…”

Section: Discussionmentioning

confidence: 99%

Eosinophil Inflammation of Nasal Polyp Tissue: Relationships with Matrix Metalloproteinases, Tissue Inhibitor of Metalloproteinase-1, and Transforming Growth Factor-beta1

Lee

Kim

et al. 2003

J Korean Med Sci

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Eosinophil and mast cell infiltrations are consistent findings in nasal polyp tissue. Previous studies have shown that matrix metalloproteinases (MMPs) may be involved in eosinophil infiltration in airway mucosa of asthmatic patients, and that transforming growth factor-beta1 (TGF-beta1) induces extracellular matrix deposition in nasal polyp tissue. The aim of this study was to evaluate the role of MMPs and tissue-inhibitor of metalloproteinase-1 (TIMP-1) in association with TGF-beta1, eosinophils and mast cell activation in nasal polyp tissue. Nasal polyp tissues from 20 patients who underwent polypectomies were collected and prepared into tissue homogenate. Eosinophil cationic protein (ECP) and tryptase levels were measured by CAP system (Pharmacia, Sweden). MMP-2, MMP-9, TIMP-1 and TGF-beta1 levels were measured by enzyme-liked immunosorbent assay. MMP-2 was the predominant form of MMPs, followed by MMP-9 and TIMP-1. There were significant correlations between ECP, and MMP-9, MMP-2, TGF-beta1 and tryptase, but not with TIMP-1. Significant correlations were noted between tryptase, and MMP-2, MMP-9, and TGF-beta1, but not with TIMP-1. Close correlations were noted between TGF-beta1, and MMP-9 and MMP-2, but not with TIMP-1. MMP-2, MMP-9, and TGF-beta1 may contribute to eosinophil and mast cell migrations into nasal polyp tissue.

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“…Likewise, avoidance of occupational agents that can cause an IgE-mediated rhinitis has a beneficial effect on surgical success rates (32). On the other hand, there are several reports (33)(34)(35) indicating that the presence of AR (as defined by positive RAST or skin prick testing) did not influence symptom severity, extent of disease on CT scan, or likelihood of surgical failure when compared to nonallergic CRS.…”

Section: Directmentioning

confidence: 99%

“…(58,59) Strong correlation between the extent of disease on CT evaluation and the amount of eosinophils within the sinus tissue, as well as the presence of specific IgE antibodies (60) CT changes in patients with ragweed allergy (61) Increased percentage of NP in allergic patients (62) Immunotherapy increases success of surgery (31,63) especially in AFRS (64) Experimental study where nasal challenge with allergen has resulted in secondary maxillary sinus inflammation (26) Possible selection or referral bias (19)(20)(21)(22)(23) No increased percentage of allergy in NP patients (59,(65)(66)(67)(68)(69) Allergic rhinitis was less prevalent in those with worse disease on sinus CT scans (56) No increase of CRS during pollen season (27) The presence of allergy does not affect symptom severity, surgery likelihood, extent of disease on CT (33)(34)(35) Pediatric literature Increased incidence of atopic predisposition in pediatric patients with sinusitis (70, 71) Correlation of allergy and severity of sinus disease (70,72) ESS in children with AR does not have a poorer outcome. Treatment for the allergy before surgery may improve the success of ESS (73) Same percentage of positive allergy test in CRS and normal children (74) Same prevalence of CRS in atopic and nonatopic children (75) Percentage of opacification the same between allergic and nonallergic adults and children (76) ESS, endoscopic sinus surgery; AFRS, allergic fungal rhinosinusitis; AR, allergic rhinitis; CRS, chronic rhinosinusitis; NP, nasal polyps.…”

Section: Conflicts Of Interestmentioning

confidence: 99%

Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation

Georgalas

Vlastos

Picavet

et al. 2014

Allergy

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The relationship between allergic rhinitis and chronic rhinosinusitis has been assessed in a number of observational and experimental studies. In this review, we attempt their synthesis and evaluation using the modified Bradford Hill guidelines for causation. Although there is no proof of causation, especially in the pediatric literature, an evaluation of underlying allergies is recommended at least as an initial measure of symptoms relief.Chronic inflammatory disorders of the upper airways are extremely prevalent and have a major impact on public health (1-5). Some review articles on chronic rhinosinusitis (CRS) have suggested that atopy predisposes to its development (6), because allergic rhinitis (AR) is a common coexisting disease in pediatric and adult patients with CRS (7).Despite the fact that acute and CRS have been shown to occur frequently in AR patients, a sound pathophysiologic mechanism has not been proven, and thus, the association between rhinosinusitis and AR remains controversial (8, 9). The hallmark of AR is an IgE-mediated (type I) hypersensitivity reaction to an inciting inhaled antigen (10) and, in some cases, an ingested food that causes a cross-reaction because of antigenic similarities between the inhalant and the food (11). On the other hand, the pathophysiology of CRS is more obscure. Although the clinical presentation and symptoms of CRSwNP and CRSsNP overlap, it appears that they are underlined by distinct pathophysiological mechanisms.For example, nasal polyps (NP) have significantly higher levels of eosinophil markers, while CRSsNP is characterized by a Th1 polarization with high levels of interferon-gamma (IFN-c) and transforming growth factor-beta (TGF-b). On the other hand, CRSwNP showed a Th2 polarization with high IL-5 and immunoglobulin (Ig) E concentration (12). One step further is to assess whether the Th2 phenotype in CRSwNP is the result of the atopic status, the presence of AR, or (allergic) asthma. We know that there are many parallels between NP and asthma (13). And even some specific gene polymorphisms present in CRS have also been found in asthma (14). Several reviews on the role of allergy in CRS, in both adults (11,15) and children (16), can be found in the recent English literature, where epidemiological and experimental studies are mentioned. However, a logical structure for investigating and defining causality in epidemiological studies, such as Bradford-Hill criteria for causation, has not been Allergy 69 (2014) 828-833

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Nasal polyps: Effects of seasonal allergen exposure

Cited by 78 publications

References 19 publications

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Eosinophil Inflammation of Nasal Polyp Tissue: Relationships with Matrix Metalloproteinases, Tissue Inhibitor of Metalloproteinase-1, and Transforming Growth Factor-beta1

Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation

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