Laryngopharyngeal reflux disease: Updated examination of mechanisms, pathophysiology, treatment, and association with gastroesophageal reflux disease.

Laryngopharyngeal reflux disease (LPRD) is an inflammatory condition in the laryngopharynx and upper aerodigestive tract mucosa caused by reflux of stomach contents beyond the esophagus. LPRD commonly presents with sym-ptoms such as hoarseness, cough, sore throat, a feeling of throat obstruction, excessive throat mucus. This complex condition is thought to involve both reflux and reflex mechanisms, but a clear understanding of its molecular mechanisms is still lacking. Currently, there is no standardized diagnosis or treatment protocol. Therapeutic strategies for LPRD mainly include lifestyle modifications, proton pump inhibitors and endoscopic surgery. This paper seeks to provide a comprehensive overview of the existing literature regarding the mechanisms, patho-physiology and treatment of LPRD. We also provide an in-depth exploration of the association between LPRD and gastroesophageal reflux disease.

[Clinical features of non-allergic rhinitis and the therapeutic efficacy of combination of intranasal steroid and H1-antihistamine].

OBJECTIVE: To investigate the basic clinical features of non-allergic rhinitis (NAR) in age, sex, incentives, and the effect of treatment with combined intranasal steroids and antihistamines. METHODS: One hundred consecutive NAR patients were included in this study and the age, gender, predisposing factors and clinical symptoms were analyzed. Combined intranasal steroids and antihistamines used for 8 weeks, the symptoms were recorded before and after treatment with visual analogue scale(VAS) score as the assessment of treatment effects. SPSS 17.0 software was used to analyze the data. RESULTS: Ninety-three NAR patients were adults, and the sex ratio was 1:1.2 (male:female), and the peak age incidence was between 30 - 39 years old. The main nasal symptoms were sneezing (96 cases), rhinorrhea (88 cases), nasal blockage (72 cases) and nasal itching (69 cases). The symptoms of eye and respiratory tract were always accompanied as eye itching (49 cases), tears (32 cases), congestion (22 cases), swelling (13 cases), cough (21 cases), suffocation (19 cases), chest compression (13 cases), wheezing (10 cases); Seventy-nine (79.0%) patients could indicate at least one kind of incentives, the temperature change (54 cases), dust (28 cases), irritating odor (21 cases) was the main incentive of NAR. Forty-seven patients completed the combined treatment of intranasal steroids and antihistamines, 38 (80.9%) patients were satisfied with the result with all symptoms relieved except wheezing (P < 0.05), but 36 patients had the NAR returned when they were exposed with the predisposing factors in the coming year; the remaining 9 (19.1%) patients failed the treatment. CONCLUSIONS: The clinical features of NAR were as follows: adult constituted the main patient population, women were slightly more than man but with no difference between genders; sneezing and nasal discharge were the main clinical symptoms, always more than 1 incentives. The combination of intranasal steroids and antihistamines could control the most of clinical symptoms.

[Survey on clinical characteristics of pediatric allergic rhinitis].

OBJECTIVE: To investigate the clinical symptom, precipitating factor, associated symptom, family history and life quality of pediatric patients with allergic rhinitis, and to analyze the characteristic of clinical symptoms. METHODS: A questionnaire survey on pediatric AR patients since June 2008 to June 2010, one hundred and forty-eight pediatric AR patients were divided into 2 groups, group A (n = 43) included children aged from 3.2 to 6.0, group B (n = 105) included children aged from 6.1 to 14.8. The severity degree of clinical symptom was assessed by visual analogue scale. RESULTS: Preschool age children had more severe rhinocleisis, more severe cough and less rhinorrhea than school age children (χ(2) value were 29.194, 12.277 and 16.904, respectively, P < 0.05). According to the classification criteria of ARIA 2008, preschool children had more mild intermittent AR and less moderate-severe persistent AR than school age children (χ(2) value were 20.370 and 24.546, P < 0.05). The precipitating factor of common cold, fitment, climate, environment factors were 22.3% (33/148), 5.4% (8/148), 16.2% (24/148), 3.4% (5/148), the others was 4.7% (7/148), no obvious precipitating factor was 48.0% (71/148). The rate of parent or parents who had allergic disease history was 11.5% (17/148). Quality of sleep that 66.2% (98/148) were upset and 62.2% (92/148) had no cathexis. CONCLUSIONS: The preschool children have different clinical symptom characteristic from the school age children, and we got some clinical data of pediatric AR patients, those were beneficial to the diagnose and therapy of pediatric AR. The clinical data obtained in this study from pediatric AR patients are beneficial to the diagnosis and therapy of pediatric AR.

[Correlation analysis of two serum specific IgE test systems and skin prick test in allergic rhinitis patients].

OBJECTIVE: To evaluate the correlation between two serum specific IgE and skin prick test (SPT) for the diagnosis of allergic rhinitis. METHODS: Two hundred and sixteen patients were referred to the allergist for a suspected allergic rhinitis between June and October in 2009. Patients were classified as positive for inhalant allergy if they had a positive clinical history and a related positive SPT for the suspected inhalant allergen. Statistical analysis was performed using SPSS13.0 software. RESULTS: One hundred and fifty-eight patients had a positive SPT, comparing with the SPT, the diagnostic indexes (accuracy, sensitivity, specificity) of the ImmunoCAP system and the AllergyScreen system were 0.810 and 0.819, 0.872 and 0.780, 0.741 and 0.862 respectively. The accuracy was similar between the two systems (χ(2) = 0.112, P > 0.05). The ImmunoCAP system had a higher sensitivity (χ(2) = 7.361, P < 0.05). The AllergyScreen system had a higher specificity (χ(2) = 10.222, P < 0.05). CONCLUSIONS: This data supported the use of ImmunoCAP system and AllergyScreen system to identify potentially significant individual allergens in the diagnosis of allergic rhinitis. The ImmunoCAP system had a higher sensitivity. The AllergyScreen system had a higher specificity. The AllergyScreen system can be used as a complementary with the ImmunoCAP system.

[Intranasal pretreatment with toll like receptor 9 ligand CpG oligodeoxynucleotides prevents the development of allergic rhinitis in juvenile guinea pigs].

OBJECTIVE: To evaluate the therapeutic effect of intranasal oligodeoxynucleotides with CpG motifs (CpG ODN) in prevention of allergic rhinitis in juvenile guinea pigs. METHODS: Juvenile guinea pigs aged from 7 to 10 weeks were administrated with CpG ODN alone or combined with OVA at single dose concentration intranasally (on day 0, 5, 10, 15 in sequence) while control and blank group were administrated with saline. Both experimental and control animals were again sensitized by OVA (on day 18, 25), and 14 days after second sensitization animals were challenged by OVA intranasally (on days 39 and 46). Two hours after challenge, the animals were sacrificed. Then Hemotoxin and Eosin stain were carried out to analyze local eosinophilic reactions and nasal lesions. Local and systemic cytokines interleukin IL-5 and IFN-γ levels were examined by ELISA. Immunofluorescence was carried out with ICAM-1 antibody. Statistical analysis was performed using a SPSS 11.0 software. RESULTS: In CpG ODN-administration or CpG ODN with OVA-administration group allergic rhinitis symptoms were not as severe as model control group (P < 0.05). Compared with the model control group, CpG ODN-administration did not increase production of OVA-specific Th1 cytokine IFN-γ but decreased productions of ovalbumin-specific Th2 cytokines IL-5 both in serum and nasal specimen (q value were 3.890 and 4.019, P < 0.05). Moreover, nasal lesions with infiltration of mean (x ± s) eosinophils (20.0 ± 9.6) in CpG group animal were prominently reduced by the CpG ODN-treatment compared with the control animals (53.5 ± 19.8) and CpG+OVA group (9.5 ± 5.7) were lower than CpG-M+OVA group (49.2 ± 18.9), the differences were significant (q value were 3.785 and 4.576, P < 0.05). Immunofluorescence results showed lower ICAM-1 expression in nasal specimen of CpG group compared with model group and CpG plus OVA group animal to CpG mimics plus OVA group (Z value were 3.697 and 3.765, P < 0.05). CONCLUSIONS: Intranasal administration of CpG oligodeoxynucleotides with or without allergen may be an effective way to prevent the development of allergic rhinitis.

Thymic stromal lymphopoietin expression is increased in nasal epithelial cells of patients with mugwort pollen sensitive-seasonal allergic rhinitis.

BACKGROUND: Excessive expression of thymic stromal lymphopoietin (TSLP) has been demonstrated in asthmatic airway epithelia and in nasal epithelia from animal models of allergic rhinitis (AR), but the evidence of expression of TSLP in nasal epithelial cells (NECs) of patients with AR is lacking. We aimed to investigate the expression of TSLP in NECs of patients with mugwort sensitive-seasonal AR and determine whether it is associated with severity of symptoms and the number of infiltrated eosinophils in nasal mucosa. METHODS: NECs specimens were obtained by scraping with plastic curettes from the nasal inferior turbinates of patients with mugwort pollen sensitive-seasonal AR (n = 22) and nonallergic controls (n = 11) during last peak mugwort pollen season. The severity of nasal symptom was assessed using a Visual Analog Scale (VAS). In addition, serum mugwort pollen IgE levels were tested from each patient. In situ hybridization (ISH) was performed to test the messenger RNA (mRNA) of TSLP in the NECs. Furthermore, immunohistochemical staining (IHC) was scored to evaluate the expression of TSLP and eosinophil cell count was made by May-Grünwald/Giemsa staining. The correlation between expression of TSLP and all other parameters was analyzed in this study. RESULTS: The mRNA level of TSLP was significantly increased in NECs of patients with AR compared with the nonallergic control group (P < 0.05). In addition, IHC results showed that expression of TSLP in NECs from patients with AR was up-regulated which was correlated with VAS score (r = 0.598; P < 0.05) and nasal eosinophils count (r = 0.702; P < 0.05), but it was unrelated with mugwort pollen specific IgE level. CONCLUSIONS: These preliminary findings indicate a potential relationship between TSLP expression, severity of symptoms and nasal eosinophils count in pathogenesis of AR, but TSLP expression did not correlate with mugwort pollen specific IgE level. The elevated expression of TSLP might play a critical role in local atopical responses of AR. In the future, the TSLP has the potential to be one of the most important molecular markers for AR diagnoses and assessment.