Nasal irrigation with Glycyrrhiza glabra extract for treatment of allergic rhinitis - A study of in vitro, in vivo and clinical trial.

ETHNOPHARMACOLOGICAL RELEVANCE: Glycyrrhiza glabra, a family of licorice and a traditional Chinese medicine with sweet taste and favorable smell, has anti-inflammatory, anti-allergic and immunomodulatory functions. AIM OF THE STUDY: We developed a licorice extract (LE) by using glycyrrhiza glabra and administered it through nasal irrigation to treat allergic rhinitis (AR). MATERIALS AND METHODS: LE was prepared into extract powder, and the anti-inflammatory effect of the LE was evaluated by calcium ionophore-induced activated mast cell model (in vitro). Then, local passive anaphylaxis assays were applied to investigate the anti-IgE-mediated allergic reaction of the LE in mice (in vivo). A developed LE was administered through nasal irrigation to treat AR in clinic settings. A total of 60 participants diagnosed with AR were included in this clinical trial; they were randomly assigned to three interventions: licorice nasal irrigation (LNI), corticosteroid nasal irrigation (CNI), and saline nasal irrigation (SNI). They performed nasal irrigation once a day for 1 month. Both subjective questionnaires (22-item Sino-Nasal Outcome Test [SNOT-22] and visual analog scale [VAS]) and objective examinations (acoustic rhinometry and nasal endoscopy) were used for effectiveness assessments. RESULTS: All three interventions could improve SNOT-22 scores, but the effects of LNI and CNI were more significant. According to VAS scores for nasal blockage, rhinorrhea, sneezing, nasal pruritus, postnasal discharge, and olfactory disturbance, the effect of LNI was superior to those of CNI and SNI. The results of rhinometry revealed that LNI significantly improved nasal resistance. Endoscopic analysis showed that both LNI and CNI, but not SNI, could significantly improve turbinate hypertrophy. Moreover, the best procedural comfort was found for LNI, which had no side effects or complications during the trial. CONCLUSIONS: LNI is a natural, safe, and innovative therapy that can effectively treat AR. Its effect is superior to those of CNI and SNI, and it has greatly improved procedural comfort.

Intranasal T-LysYal® as adjunctive therapy for patients after functional endoscopic sinus surgery.

Functional Endoscopic Sinus Surgery (FESS) is a common day surgery technique for upper airway disorders. Hyaluronic acid (HA) is a fundamental component of the human connective tissue. HA may exert reparative, anti-inflammatory and immune-modulating activities. Recently, a new intranasal HA formulation has been proposed: a supramolecular system containing lysine hyaluronate, thymine and sodium chloride (T-LysYal®). This randomized study investigated whether intranasal T-LysYal® (RinoLysYal®, Farmigea, Italy) was able to reduce symptom severity, endoscopic features, and nasal cytology in 83 patients (49 males and 34 females mean age 45.4±6.2 years) treated with FESS. All patients were treated with isotonic saline solution for 4 weeks, and a sub-group (active group) was also treated with intranasal T-LysYal®. Patients were visited at baseline, after treatment, and after 4-week follow-up. Intranasal T-LysYal® treatment significantly reduced the quote of patients with symptoms, endoscopic features, and inflammatory cells in comparison to isotonic solution. In conclusion, the present study demonstrates that intranasal T-LysYal® is able to significantly improve patients after FESS and its effect is long lasting.

Endoscopic-guided versus cotton-tipped applicator methods of nasal anesthesia for transnasal esophagogastroduodenoscopy: a randomized, prospective, controlled study.

BACKGROUND: Ultrathin transnasal esophagogastroduodenoscopy (UT-EGD) is well tolerated by patients, but the methods of nasal anesthesia are various. AIM: To compare patient tolerance, safety, and adverse events between the endoscopic-guided (EGNA) and cotton-tipped applicator (CTNA) methods of nasal anesthesia. METHODS: Between September 2005 and September 2006, we conducted a prospective, randomized, controlled study in a large tertiary referral hospital in eastern Taiwan. In total, 235 consecutive patients were randomly assigned to the CTNA group or EGNA group before unsedated UT-EGD. We compared demographic data, procedural discomfort using a validated 5-point visual analog scale, optical quality, total procedure time, and adverse events between the two groups. RESULTS: After randomization and exclusion, 101 (43 men and 58 women) and 103 (44 men and 59 women) patients were allocated to the CTNA and EGNA groups, respectively. Baseline characteristics and periprocedural hemodynamics of patients in the two groups were similar. There was no statistical difference in insertion failure rates between the two methods (CTNA 10.9%vs EGNA 7.7%, P= 0.59). Pain scores during both anesthesia (2.3 +/- 0.4 vs 3.5 +/- 0.6, P < 0.001) and insertion (2.8 +/- 1.2 vs 3.8 +/- 1.8, P < 0.001) were significantly lower in the EGNA group; however, the sensation of bad taste was significantly worse in the EGNA group (2.3 +/- 1.3 vs 1.9 +/- 1.4, P= 0.040). Less epistaxis happened in the EGNA group than in the CTNA group. The EGNA method had a significantly better visual capacity and shorter procedure time. More patients in the EGNA group said they would like to receive the same procedure the next time. CONCLUSION: Compared with the CTNA method, in which the taste of lidocaine gel was more acceptable, EGNA appeared to be more tolerable, caused less epistaxis, improved visualization capacity, and reduced procedure time.

Antiinflammatory effect of Japanese horse chestnut (Aesculus turbinata) seeds.

The antiinflammatory effects of Japanese horse chestnut (Aesculus turbinata) seeds were examined in vivo and in vitro. The extract of this seed (HCSE) inhibited croton oil-induced swelling of the mouse concha. HCSE inhibited cyclooxygenase (COX) -1 and -2 activities, but had no effect on 15-lipoxygenase and phospholipase A2 activities. Inhibition of COX-2 occurred at a lower concentration of HCSE than for COX-1. Japanese horse chestnut seeds contain coumarins and saponins, but these chemicals did not inhibit COX activities. These results suggest that the antiinflammatory effect of Japanese horse chestnut seeds is caused, at least partly, by the inhibition of COX. The inhibitor of COX in this seed may be a chemical(s) other than coumarins and saponins.

Nasal pressure-volume relationships determined with acoustic rhinometry.

Partitioning of ventilation has been hypothesized to be related to nasal pressure-volume relationships, relationships that have been difficult to measure. Regional differences in nasal passage pressure-volume relationships are likely because the nasal valve and anterior turbinate are structurally different, but both are altered by agents that alter vascular tone. This study determined nasal volume-to-pressure ratio (NVPR) on six healthy nonsmoking subjects by measuring nasal volume by using acoustic rhinometry at pressures ranging between -14 and +14 cmH2O on 3 days: baseline, after intranasal decongestion (oxymetazoline), and congestion (histamine). NVPR was lower in the nasal valve (0.07 +/- 0.01 cm3/cmH2O) than in the anterior portion of the turbinates (0.29 +/- 0.05 cm3/cmH2O; P < 0.005). Oxymetazoline decongestion decreased NVPR in the nasal valve by 23% and NVPR in the anterior portion of the turbinates by 47%. Histamine did not alter NVPR at either site. Nasal resistance changes correlated with changes in nasal valve and anterior turbinate volume. In summary, regional differences in nasal pressure-volume relationships exist and changes occur with pharmacologically induced vascular decongestion.