Diagnostic use of enzymatic RAST skin tests and determination of eosinophils in nasal mucosa in allergic rhinitis

AIMS: Allergic rhinitis is the most frequent disease mediated by immunoglobulin E (IgE). Nasal challenge is the gold standard for the diagnosis of allergic rhinitis. Skin tests (ST) are the most used diagnostic method to detect the presence of specific IgE bind to skin mast cells. The exposition of the nasal mucous membrane to the allergen is followed by an increase of the local eosinophils; the count of eosinophils in nasal mucous (ENM) is a diagnostic test for allergic rhinitis. Enzymatic RAST or enzymatic allergo-sorbent test (ESA) measures the level of serum allergen-specific IgE. OBJECTIVE: To measure the sensitivity, specificity, and diagnostic precision of ST, EAST and ENM in allergic rhinitis. METHOD: We studied 241 individuals, 162 of them had allergic rhinitis, and 79 were healthy controls. They underwent nasal challenge and intradermic ST for Dermatophagoies spp (acarus). Fraxinus americana (Ash-tree), Amaranthus palmieri (quelite), Cynodon Dactylon (capriola) and Felis catus (cat), EAST for Dermatophagoides pteronyssinus (acarus), and ENIVI. Results of ST, EAST and ENIVI were compared with their corresponding nasal challenge, and the prevalence of allergic rhinitis for each allergen was calculated. The best cut point was assessed by means of receiver-operator curves (ROC), and sensitivity, specificity, positive predictive value, negative predictive value, inter-observer concordance coefficient, area under ROC (0), standard error of 0 (SEO), and 95% confidence interval of 0 of each test were calculated using the best cut point. RESULTS: ST and EAST had the best sensitivity and specificity. ENM had the lowest sensitivity and specificity. CONCLUSION: For the diagnosis of Dermatophagoides spp allergic rhinitis ST for Dermatophagoides spp and EAST for Dermatophagoides pteronyssinus have the same diagnostic precision. According to the indexes for diagnostic precision, and inter-observer concordance coefficient, ST and EAST are useful to diagnose allergic rhinitis induced by the evaluated allergens. ENIVI is a test that is not very useful for the diagnosis of allergic rhinitis.     

The prevalence of allergic rhinitis and nasal symptoms in Nottingham

An overview of the most important older and newer results regarding the relationship between violent and criminal behavior on the one hand and schizophrenic illness on the other hand is presented. Four different methods are available to study this relationship: (i) study of the prevalence of mental illness in criminal/violent populations; (ii) study of criminality/violence rate in samples of psychiatric patients; (iii) study of criminality/violence in community samples comparing mental patients with non-patient community residents; and (iv) study of criminality/violence in birth cohorts prospectively. All these methods have been used; but samples composed of schizophrenic patients exclusively were only exceptionally studied. The results indicate that there is a modest but significant relationship between schizophrenia and violence and crime which persists even after controlling for demographic and socio-economic variables. The probability of schizophrenic patients to be criminal or violent depends on the acuity of their illness and is increased by their use of psychoactive substances. Generally, however, violent and criminal acts directly attributable to mental illness account only for a very small proportion of such acts in the society.     

Anterior rhinomanometry in nasal allergen challenges

Even simple and relatively safe provocation procedures like nasal allergen challenges, should aim to allow detection of positivity with the less possible discomfort to the patient. The objective of this work was to evaluate if the use of rhinomanometric measurements during nasal provocation procedures could allow a decrease in the total administered allergen dose, causing less symptoms to the patients but without increasing the number of false-negatives, comparatively to clinical scores or nasal peak-flow measurements. Our results showed that performing rhinomanometric measurements during nasal HDM challenge procedures can lead in many patients to a reduction in the total dose of allergen administered during the challenge, without loss of sensitivity or specificity. This allergen dose reduction translates in less time consumed during the provocation and less patients' discomfort.     

Tryptase determination in nasal washings in patients with allergic rhinitis]

An 8-year-old Italian boy, born to consanguineous parents, with clinical, histopathologic, and ultrastructural findings of lipoid proteinosis is reported. The main signs of the syndrome-papulonodular, hyperkeratotic and verrucous lesions distributed over the skin of the head and extremities, hoarseness, and dysphagia-were present in the child. The mother had papulonodular lesions on her hands and also complained of slowness in healing.     

Onset of action of aqueous beclomethasone dipropionate nasal spray in seasonal allergic rhinitis

Beclomethasone dipropionate nasal spray is widely used in the treatment of seasonal allergic rhinitis; however, the time of onset of action has not been determined. This study assessed the onset of action, level of relief, and efficacy of beclomethasone nasal spray in patients with seasonal allergic rhinitis. In a double-blind, randomized, placebo-controlled, parallel-group, multicenter, 7-day study, symptomatic patients were administered two inhalations of beclomethasone dipropionate (n = 80) or placebo (n = 81) into each nostril twice daily. Patients assessed the onset of action and level of relief at 6, 24, and 48 hours and at days 3 and 7. Investigators evaluated symptoms at days 0, 3, and 7 and response to therapy at days 3 and 7. The difference in the cumulative number of patients reporting relief of symptoms was statistically significant in favor of beclomethasone dipropionate by hour 24 (P = 0.05). Patients in the beclomethasone dipropionate group experienced a greater level of relief than patients receiving placebo at hour 24, and improvement increased over the 7-day study compared with a decrease in relief in the placebo group. Beclomethasone dipropionate was significantly more effective than placebo in reducing symptoms (P < or = 0.02), and patients in the beclomethasone dipropionate group showed a more favorable response to treatment than did patients in the placebo group (P < 0.01). Adverse events were minor in both groups. Beclomethasone dipropionate nasal spray produced significant onset of relief of symptoms the first day of treatment; improvement was sustained and increased over the course of the study.     

Kinins and kallikrein in nasal secretion after antigen challenge in patients with allergic rhinitis

This study showed that nasal allergy patients have increased nasal airway resistance and tissue kallikrein activity in nasal lavage in accordance with the severity of symptoms. Nasal airway resistance and tissue kallikrein activity were significantly increased in the nasal lavage collected 15 min after antigen challenge, placement of a disk containing house dust antigen. The free kinin level in the nasal lavage collected 15 min after the antigen challenge was also markedly increased. Pretreatment of patients with d-chlor-pheniramine maleate (histamine H1 receptor antagonist) blunted this increase in nasal airway resistance and tissue kallikrein activity 15 min after the antigen challenge, suggesting that histamine may accelerate excretion of tissue kallikrein in nasal secretions. Camostat mesilate inhibited the in vitro tissue kallikrein activity in nasal lavage collected from allergy patients. Administration of camostat mesilate significantly inhibited nasal airway resistance and tissue kallikrein activity in nasal lavage after the antigen challenge, indicating that kinin generated in the nasal cavity increased nasal airway resistance. These results suggest that tissue kallikrein inhibitors may serve as anti-allergic drugs by suppressing the nasal symptoms of nasal allergy patients.     

The reaction of the nasal mucosa in allergic rhinitis to cold saline stimulus

To clarify the nature of the reaction pattern of the nasal mucosa in allergic rhinitis, nasal lavage using a cold saline solution of 4 degrees C and a warm saline solution was attempted in 8 patients with nasal allergy to the pollen of the Japanese cedar and cypress in a non-scatter season, and the concentration of protein contents in the nasal washings was determined. The concentrations of total protein, albumin and 26 kD protein were higher in cold saline than in the warm saline lavage. In particular, the concentration of 26 kD protein was 5.3 times higher. However, the concentration was not very high compared with the value obtained by warm saline lavage in the scatter season. These findings indicate that the nasal mucosa of patients with allergic rhinitis is reactive to cold saline stimuli even in the non-scatter season.     

The relationships between nasal hyperreactivity, quality of life, and nasal symptoms in patients with perennial allergic rhinitis

BACKGROUND: A clinical test that could inform the clinician about the severity of a patient's nasal symptoms and health-related quality of life (QOL) would be very useful. OBJECTIVE: We attempted to determine whether, in patients with perennial allergic rhinitis, nasal challenge with histamine could be used to estimate daily symptoms and QOL. METHODS: Forty-eight patients with perennial allergic rhinitis were challenged with histamine to determine nasal hyperreactivity. Nasal response was monitored by the number of sneezes, the amount of secretion, and a symptom score. Daily nasal symptoms were recorded during the 2 preceding weeks. Patients also completed a rhinitis QOL questionnaire. RESULTS: Responsiveness to histamine and total daily nasal symptoms were moderately correlated (r = 0.51, p = 0.001). Comparison of total daily nasal symptoms with the overall QOL score showed a moderate correlation (r = 0.59, p < 0.001). Nasal response to histamine and overall QOL score were also correlated (r = 0.43, p = 0.002). However, overall QOL and daily nasal symptoms could be predicted by wide 95% confidence intervals only for each decade of nasal responsiveness to histamine (expressed as a composite symptom score). CONCLUSION: In patients with perennial allergic rhinitis nasal hyperreactivity as determined by histamine challenge, QOL, and daily nasal symptoms are moderately correlated. Therefore nasal histamine challenge can be used as a tool for estimating the severity of daily nasal symptoms and QOL, although it cannot predict nasal symptoms and QOL very accurately.     

Diagnostic problems before specific immunotherapy in patients with late-summer seasonal allergic rhinitis

Skin prick tests were performed on 245 patients with late summer seasonal allergic rhinitis, and of these patients, 135 specific serum IgE test were performed. On the basis of skin prick test results, 94% of the patients were found to be sensitive to Ragweed: 18% of these patients had monosensitisation to Ragweed, and 56% were sensitive not only to Ragweed but also to Mugwort. The correlation between results of skin prick tests and specific serum IgE tests was found to be very good (95%) with Ragweed antigen experiencing no problem in the diagnostic process before immunotherapy. However, in 48% of patients with positive skin prick tests to Mugwort the specific serum IgE was found to be negative. Before immunotherapy, a specific nasal provocation test was performed on 12 of these patients with Mugwort to examine the real sensitivity of the shock-organ. This careful allergen research will demonstrate which components of allergen extract should be used for immunotherapy in late summer seasonal allergic rhinitis patients.     

Management of allergic rhinitis

Allergic rhinitis constitutes one of the commonest causes for visits to a general practitioner. An increased understanding of the pathophysiology of the condition has led to a more rational use of the pharmacological agents available to treat this troublesome condition. Identification of the offending allergens is essential if rational approaches to management are to be employed.     

Fluticasone propionate aqueous nasal spray is safe and effective for children with seasonal allergic rhinitis

INTRODUCTION: Fluticasone propionate aqueous nasal spray, a new topical corticosteroid preparation, is effective when given as 200 micrograms once daily in patients (> 12 years of age) with seasonal allergic rhinitis. STUDY OBJECTIVE: To evaluate the efficacy and safety of fluticasone proprionate aqueous nasal spray in children aged 4 to 11 years with seasonal allergic rhinitis. STUDY DESIGN: Multicenter, randomized, double-blind, placebo-controlled, parallel-group. PATIENTS: Two hundred fifty children aged 4 to 11 years with moderate-to-severe nasal symptoms, a positive skin test reaction to a late-summer or autumn allergen, a history of seasonal allergic rhinitis, and documentation of an unsatisfactory response to conventional treatment. INTERVENTIONS: Children were randomly assigned to receive fluticasone propionate, either 100 micrograms or 200 micrograms, or placebo, given by intranasal spray once daily in the morning for 14 days. MEASUREMENTS AND RESULTS: Severity of nasal symptoms (obstruction, rhinorrhea, itching, and sneezing) was recorded on visual analog scales by investigators at weekly visits and by patients (or adult guardian) daily in the evening. According to investigator and patient ratings, both fluticasone propionate 100 micrograms/d and 200 micrograms/d lowered total nasal symptom scores when compared with placebo. Both dosages of fluticasone propionate were more effective than placebo on the basis of investigator-rated overall clinical evaluation of efficacy at the end of treatment, with significant improvement (as opposed to moderate or mild improvement, no change or worsening) noted in 21% to 29% of the active-treatment groups vs 9% in the placebo group. There were no significant differences between the two fluticasone propionate dosages in any efficacy measurement. Morning plasma cortisol concentrations and frequency of drug-related adverse events were similar in the fluticasone propionate and placebo groups. CONCLUSION: In children as young as 4 years, 100 micrograms of fluticasone propionate aqueous nasal spray given once daily is as effective as 200 micrograms given once daily, the usual adult dose for the treatment of seasonal allergic rhinitis. Both fluticasone propionate dosages were well tolerated and neither dosage appears to interfere with the hypothalamic-pituitary-adrenal axis in children.     

Nedocromil sodium 1% nasal spray in the treatment of allergic rhinitis caused by Dermatophagoides pteronyssinus

We have evaluated the efficacy of Nedocromil sodium 1% nasal solution in 36 patients (20 females and 16 males, mean age 29.5 years) suffering from perennial allergic rhinitis caused by Dermatophagoides pteronyssinus. Nedocromil sodium was given four times a day for 2 months. On a daily card patients had to report the severity of the considered symptoms (runny, nose, sneezing, itchy nose and stuffy nose) following an arbitrary score from 0 to 3 (0 = no symptom, 1 = mild, 2 = moderate, 3 = severe). Clinical evaluation was performed after 1 month and at the end of the treatment. We observed a statistically significant decrease of the considered symptoms already after a one month therapy. This improvement was higher after two months (p < 0.001). No side effects have been reported and no concomitant symptomatic therapy was needed. Nedocromil sodium is therefore a safe and efficacious drug in the treatment of allergic rhinitis caused by Dermatophagoides pteronyssinus.     

Evaluating the sensation of nasal obstruction with acoustic rhinometry and rhinomanometry

The relationships among subjective sensation of nasal obstruction, data of rhinomanometry and acoustic rhinometry between individuals or for each individual were explored. Thirty-nine subjects with nasal obstruction problems were examined using the visual analogue scale, nasal airflow resistance (NAR), nasal minimal cross-sectional area (MCA), and nasal cavity volume (NCV). No significant correlation was found between the sensation of unilateral or bilateral nasal obstruction to NAR, MCA, or NCV. Strong correlations between MCA and NAR, and NCV and NAR were noted in this study. Another 10 healthy volunteers were investigated and correlation was studied on each individual level. Strong correlations within subject were found more commonly in persons with short-term follow-up than with the long-term follow-up group. In the present study, rhinomanometry results were compatible with acoustic rhinometry results. However describing the sensation of nasal patency with only rhinomanometric or acoustic rhinometric measurements seems still inadequate.     

Evaluation and management of allergic rhinitis

The semaphorin/collapsin gene family is a large and diverse family encoding both secreted and transmembrane proteins, some of which are thought to act as repulsive axon guidance molecules. However, the function of most semaphorins is still unknown. We have cloned and characterized several semaphorins in the zebrafish in order to assess their in vivo function. Zebrafish semaZ2 is expressed in a dynamic and restricted pattern during the period of axon outgrowth that indicates potential roles in the guidance of several axon pathways. Analysis of mutant zebrafish with reduced semaZ2 expression reveals axon pathfinding errors that implicate SemaZ2 in normal guidance.     

Reduction of soluble ICAM-1 levels in nasal secretion by H1-blockers in seasonal allergic rhinitis

ICAM-1, a transmembrane glycoprotein promoting adhesion in immunologic and inflammatory reactions, was found to be increased on nasal epithelial cells of patients with allergic rhinitis. Loratadine, an H1-blocker, was found to reduce in vitro the expression of ICAM-1 on nasal epithelial cells. A double-blind, parallel-group study was carried out during the pollen season to compare the effect of two H1-blockers, cetirizine (10 mg OD) and loratadine (10 mg OD), on the release of soluble ICAM-1 in nasal secretions. A group of untreated patients was used as a control group. sICAM-1 was measured by enzyme immunoassay before and after 2 weeks of treatment. Symptoms were significantly decreased in the actively treated groups. sICAM-1 levels were unchanged in the control group but were significantly reduced in the two treated groups (P < 0.015, Wilcoxon's W test). This study shows that two H1-blockers, loratadine and cetirizine, have a similar effect on sICAM-1 released in nasal secretions during the pollen season.     

Tunica propria in chronic allergic rhinitis. Electron-microscopic study. I. The nasal blood vessels

The fine structure of human nasal blood vessels was studied in 15 chronic allergic patients. The venules showed gaping of the interendothelial junctions and lamination of the basal lamina. The capillaries displayed numerous endothelial cytoplasmic processes. The arteriolar walls showed thinning and destructive changes. A reciprocal relation between the vascular endothelium and its basal lamina was deduced.