Use of corticosteroids for nasal allergy in children.

A literature review is presented regarding studies of systemic and side effects of corticosteroids for topical treatment in the airways. Systemic effects studied are plasma and urine cortisol, with and without cosyntropin stimulation test. Generally, doses lower than 400 microg had no discernible effects. All studies found were performed on adults. Side effects are, e.g. cataract, septal perforation, and bone growth retardation. The latter side effect is studied in children with asthma, e.g. with knemometry. Generally, doses of 400 microg a day or less of 'modern' corticosteroids did not reduce the growth rate. No report is found concerning septal perforation in children.

Concentration of immunoglobulins in nasal secretion from children with recurrent infections in the upper airways.

Concentrations of immunoglobulin G (IgG), IgA, IgE and albumin were determined in nasal secretion from 14 children suffering from chronically recurrent infections in the upper airways and from normal subjects. The only statistically significant difference observed was increased albumin values during infection.

Secretory leukocyte protease inhibitor in normal, allergic and virus induced nasal secretions.

Secretory leukocyte protease inhibitor (SLPI) and alpha-1-proteinase inhibitor (alpha-1-PI), both inhibitors of granulocyte elastase, were studied in nasal secretions from healthy persons and from patients with allergic rhinitis and common cold. SLPI and granulocyte elastase were found in all samples, while alpha-1-PI was lacking in several. In all three groups SLPI was found in an active form and in excess of granulocyte elastase, which thus was completely inhibited. The results indicate that SLPI is the main inhibitor in nasal secretions and that alpha-1-PI plays a minor role.

Methodological aspects of nasal allergen challenges based on a three-year tree pollen immunotherapy study.

During 3 years of immunotherapy with tree pollen extracts, 31 patients were provoked annually. Changes in nasal reactivity were followed by registration of expiratory nasal peak flow, number of sneezes, and amount of secretion. The reproducibility of the peak flow measurements was studied. The results from all three parameters were used to form a total nasal provocation score which, better than each parameter separately, could demonstrate the variation in sensitivity. Provocation with an allergen concentration of 1 HEP was the most effective means of showing changes in specific sensitivity of nasal mucosa.

Topical corticosteroids and nasal reactivity.

The etiology of perennial non-allergic rhinitis and nasal polyposis is still not properly understood. Non-specific hyperreactivity forms a major significant symptom. Topical steroids have been used in the treatment of these diseases for about ten years. Their mode of action is still largely unknown. Various test methods in clinical trials can improve our knowledge. The effect of budesonide given intranasally as an aerosol was tested in 22 patients with perennial rhinitis. In another trial the effect of beclomethasone dipropionate (BDP) was compared when given as an aerosol and as a powder. Today we know not only that budesonide and the two forms of BDP are clinically efficacious but also that intranasal steroid treatment can reduce metacholine-induced nasal secretion, reduce the sensitivity of mucosal irritant receptors, and lower the number of basophilic as well as eosinophilic cells in the nasal secretion.

Hyposensitization in allergic rhinitis. Immunotherapy. Indications and contra-indications.

Immunotherapy in allergic rhinitis should be initiated only when other efforts at elimination and treatment of symptoms prove ineffective. The indications become more convincing if symptoms of bronchial hyperreactivity and asthma are also present. General preconditions which must be fulfilled prior to treatment are the establishing of a precise diagnosis, and that the allergen planned for treatment must play a decisive part in the disease. The main contra-indications are other, concurrent immunological diseases, and pregnancy.

Methods for assessing nasal reactivity.

Three symptoms have to be evaluated in order to get a full view of nasal reactivity: sneezing, blockage and secretion; the background mechanisms for these symptoms are discussed. It is emphasized that the demand for accuracy in the test situation varies with the indication for the provocation test. A review of different application methods and substances used for provocation tests is given. Methods for assessment of the amount of secretion and changes of nasal airway resistance are discussed in more detail.

Scanning electron microscopy of a bacterial infection of the human nasal mucosa.

Scanning electron micrographs of a bacterial infection of the human nasal mucosa indicate that the surface attachment of bacteria to epithelial cells is of significance for their pathogeneity in the airways. It is suggested that further scanning electron microscopic studies of natural and experimental infected human nasal mucosa can give valuable information about the initial interaction between micro-organisms and host cell and add to our understanding of airways infections.

Rhinomanometry and nasal peak expiratory and inspiratory flow rate.

Variation in nasal patency can be studied by rhinomanometry as well as by nasal expiratory and inspiratory peak flow rate. The accuracy of 12 sets of peak flow meters was tested in a standardized way using a pump. Differences between flow meters were found. Consequently it is recommended for a patient to use the same flow meter throughout a study. Comparison between nasal expiratory and inspiratory peak flow was performed before and after provocation of 12 grass pollen-allergic patients. Inspiratory peak flow showed certain advantages compared with expiratory peak flow measurements. The results can best be expressed as the means rather than the top values of three consecutive registrations. Twelve healthy subjects were also tested with rhinomanometry, nasal expiratory and inspiratory peak flow before and after decongestion with nose spray. Comparisons among the three methods showed significant correlations.

Rhinomanometry in routine allergen challenge.

Ten patients with allergic rhinitis due to grass pollen were challenged out of season with increasing concentrations of a well defined grass pollen extract. The reactions to challenge were followed by active anterior rhinomanometry at rest and just after exercise, rhinoscopy, counting of sneezes, measurement of secretion, and registration of the patient's subjective symptoms. It was not possible to detect a positive reaction earlier with rhinomanometry than the other methods. Thus, rhinomanometry does not seem necessary in routine allergologic work.

Intra-nasal beclomethasone dipropionate in vasomotor rhinitis.

Twenty-one patients with vasomotor rhinitis, with no relevant allergens known, completed a special double-blind trial of beclomethasone dipropionate aerosol (BDA) and placebo intra-nasally. Each patient took 200, 400 and 800 mug BDA and placebo during four consecutive 2-week periods and in different sequences. The symptom scores of the last week of each period of nasal blockage, watery secretion and sneezing were significantly reduced by all doses of BDA as compared with placebo. There were no differences between the effects of the different doses of BDA except for secretion, which was reduced more by using 800 than 200 mug. Cortisol in serum and 17-hydroxycorticosteroids in 24-hour urine were not significantly changed by BDA treatment and no increased frequency of pathogenic bacteria or fungi could be demonstrated in the nasal secretion. For treatment of patients with vasomotor rhinitis, intra-nasal BDA in a daily dose of 200 mug can be recommended when antihistamines, sympathomimetic drugs and sodium cromoglycate are not sufficiently effective.

Studies on allergen and allergoid preparations from purified timothy (Phleum pratense) pollen extracts. III. Comparative investigations by skin prick tests and nasal provocation tests.

The allergenic activities of allergen (GEN) and allergoid (GOID) preparations from partially purified timothy pollen extract were investigated in quantitative skin prick tests and nasal provocation tests. In skin prick test GOID yielded significantly less activity than GEN. Approximately 90 times more protein of GOID than of GEN was necessary to elicit wheals of the same mean size as 1 mg/ml histamine control solution (1 HEP). In nasal provocation the patients seemed to react differently with respect to their nasal sensitivity to GOID. One group of patients showed equal sensitivity to GOID and GEN, whereas the second group showed higher thresholds to GOID. These differences in nasal sensitivity to GOID could be of practical value to predict the optimal dosage schedule for the treatment of patients with GOID.