Orally Exhaled Nitric Oxide in Patients with Seasonal Allergic Rhinitis during Natural Pollen Season

Ciebiada, Maciej; Cichocki, Piotr; Kasztalska, Karolina; Majewski, Sebastian; Górska-Ciebiada, Małgorzata; Górski, Paweł

doi:10.2500/ajra.2012.26.3720

Cited by 9 publications

(4 citation statements)

References 32 publications

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“…Exhaled breath from patients with allergic rhinitis or asthma has been shown to contain higher NO ˙ levels compared to healthy controls. Exhaled NO ˙ was demonstrated to be significantly elevated in allergic rhinitis during the nonpollen season, whilst others reported a further increase in the pollen season [73, 74]. Plasma NO ˙ metabolite levels could not be related to asthma, allergic sensitization or allergic rhinitis disease phenotypes in a study involving 523 individuals [75].…”

Section: No˙ In Allergymentioning

confidence: 99%

Tryptophan Metabolism in Allergic Disorders

Gostner¹,

Becker

Kofler³

et al. 2016

Int Arch Allergy Immunol

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Allergic diseases such as asthma and rhinitis, as well the early phase of atopic dermatitis, are characterized by a Th2-skewed immune environment. Th2-type cytokines are upregulated in allergic inflammation, whereas there is downregulation of the Th1-type immune response and related cytokines, such as interferon-γ (IFN-γ). The latter is a strong inducer of indoleamine 2,3-dioxygenase-1 (IDO-1), which degrades the essential amino acid tryptophan, as part of an antiproliferative strategy of immunocompetent cells to halt the growth of infected and malignant cells, and also of T cells - an immunoregulatory intervention to avoid overactivation of the immune system. Raised serum tryptophan concentrations have been reported in patients with pollen allergy compared to healthy blood donors. Moreover, higher baseline tryptophan concentrations have been associated with a poor response to specific immunotherapy. It has been shown that the increase in tryptophan concentrations in patients with pollen allergy only exists outside the pollen season, and not during the season. Interestingly, there is only a minor alteration of the kynurenine to tryptophan ratio (Kyn/Trp, an index of tryptophan breakdown). The reason for the higher tryptophan concentrations in patients with pollen allergy outside the season remains a matter of discussion. To this regard, the specific interaction of nitric oxide (NO∙) with the tryptophan-degrading enzyme IDO-1 could be important, because an enhanced formation of NO∙ has been reported in patients with asthma and allergic rhinitis. Importantly, NO∙ suppresses the activity of the heme enzyme IDO-1, which could explain the higher tryptophan levels. Thus, inhibitors of inducible NO∙ synthase should be reconsidered as candidates for antiallergic therapy out of season that may abrogate the arrest of IDO-1 by decreasing the production of NO∙. Considering its association with the pathophysiology of atopic disease, tryptophan metabolism may play a relevant role in the pathophysiology of allergic disorders.

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Section: No˙ In Allergymentioning

confidence: 99%

Tryptophan Metabolism in Allergic Disorders

Gostner¹,

Becker

Kofler³

et al. 2016

Int Arch Allergy Immunol

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“…Although patients in the present study were diagnosed without asthma, most of them in both treatment groups had increased fractional NO at baseline, possibly indicating presence of subclinical allergic inflammation within the lower airways, as indicated by Ciebiada and colleagues. 34 Although there was no difference in the number of participants with FeNO ≥30 ppb between the two treatment groups at baseline, treatment for 14 days with BD + MNT significantly reduced the number of participants with FeNO ≥30 ppb by 50%, whereas it was not significantly altered by BD alone. Furthermore, the finding from the present study that BD + MNT was significantly more effective than BD in reducing the FeNO concentrations suggests a protective effect of MNT against lower airway inflammation.…”

Section: Discussionmentioning

confidence: 86%

“…Exhaled nitric oxide (eNO) is an easily measurable endogenous molecule, which is usually assessed as a noninvasive marker in asthma, including milder stages of the disease. 25,33 A study by Ciebiada and colleagues 34 has demonstrated that eNO is also increased in AR patients without asthma, especially during the pollen season, suggesting that subclinical allergic inflammation may be present within the lower airways of nonasthmatic patients with SAR. Although patients in the present study were diagnosed without asthma, most of them in both treatment groups had increased fractional NO at baseline, possibly indicating presence of subclinical allergic inflammation within the lower airways, as indicated by Ciebiada and colleagues.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Trial of Comparing a Combination of Montelukast and Budesonide With Budesonide in Allergic Rhinitis

et al. 2019

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Objectives/Hypothesis: It is not unequivocally proven whether a combination of an intranasal corticosteroids (INSs) and a cysteinyl leukotriene receptor antagonist has greater efficacy than INSs in the treatment of seasonal allergic rhinitis (SAR). Study Design: Single-center, randomized, open-label study. Methods: Study subjects included 46 participants with SAR. Participants were randomized to receive budesonide (BD; 256 μg) plus montelukast (MNT; 10 mg) (BD + MNT) or BD alone (256 μg) for 2 weeks. Visual analog scale scores for five major symptoms of SAR, nasal cavity volume (NCV), nasal airway resistance (NAR), and fractional exhaled nitric oxide (FeNO) were assessed before and at the end of treatments. Results: Both treatments significantly improved the five main SAR symptoms from baseline; however, BD + MNT produced significantly greater improvements in nasal blockage and nasal itching compared to BD alone. At baseline, the nasal blockage score was significantly correlated with NCV and NAR (r = −0.473, P = .002 and r = −0.383, P = .013, respectively). After 2 weeks of treatment, BD + MNT significantly improved NCV, but not NAR, to a greater level than BD. The number of patients with FeNO concentration ≥ 30 ppb at baseline was significantly decreased after BD + MNT treatment, but not after BD treatment. Similarly, BD + MNT treatment led to a significantly greater decrease in FeNO concentration than BD treatment. Conclusions: BD + MNT treatment may have an overall superior efficacy than BD monotherapy for patients with SAR, especially in improvement of nasal blockage, itching, and subclinical lower airway inflammation. Also, NCV and NAR could be used to assess nasal blockage more accurately.

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“…At the forefront is the unified airway hypothesis, which states that both upper and lower airway allergic symptoms are manifestations of the same atopic disease [11]. Asthma and rhinitis share many pathophysiologic characteristics [12] and studies suggest that subclinical allergic inflammation is present in the lower airway of patients with allergic rhinitis [13]. Clinically, both allergic rhinitis and asthma are triggered by many of the same environmental allergens [14].…”

Section: Introductionmentioning

confidence: 99%

Association between allergic rhinitis and asthma in a Northern Alberta cohort

Jeffery

Bhutani

Vliagoftis

et al. 2013

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundMany published epidemiologic studies confirm a marked increase in the prevalence of asthma and allergic rhinitis. The link between allergic rhinitis and asthma has been extensively studied and approximately 75% of patients with asthma have allergic rhinitis. The proportion of patients with asthma in populations of allergic rhinitis patients has not been well studied.ObjectiveThe purpose of this study is to estimate the prevalence of undiagnosed asthma in a specific population of patients presenting to an Otolaryngologist with symptoms of allergic rhinitis.Study designProspective cohort study. Methods: Patients presenting with symptoms of allergic rhinitis to two tertiary care Rhinology practices in Northern Alberta were asked to undergo allergy skin testing, serum IgE quantification, and pulmonary functional testing. Patients with previous asthma screening or known history of reactive airway disease or asthma were excluded.Results107 patients with allergic rhinitis symptoms were recruited between September 2010 to January 2013. Patients predominantly had perennial or persistent rhinitis (64.5%) with moderate-severe symptoms (50.5%). While only 14.9% of patients had abnormal IgE levels, 68.8% had positive skin testing. Abnormal pulmonary function tests were obtained in 39.1% of patients and 26.1% of patients were diagnosed with asthma.ConclusionsThere is a high prevalence of undiagnosed asthma in patients presenting to tertiary Rhinology care with moderate to severe allergic rhinitis symptoms. Screening lung function testing should be considered in this patient population.

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Orally Exhaled Nitric Oxide in Patients with Seasonal Allergic Rhinitis during Natural Pollen Season

Abstract: Natural exposure may lead to an elevation of ENO in the patients with SAR without asthma. We estimate that the increased ENO may result from subclinical allergic inflammation present within the lower airways of nonasthmatic patients with SAR.

Cited by 9 publications

References 32 publications

Tryptophan Metabolism in Allergic Disorders

Tryptophan Metabolism in Allergic Disorders

A Randomized Trial of Comparing a Combination of Montelukast and Budesonide With Budesonide in Allergic Rhinitis

Association between allergic rhinitis and asthma in a Northern Alberta cohort

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