Nasal IL-13 production identifies patients with late-phase allergic responses.

BACKGROUND: There is limited knowledge on how local cytokine secretion patterns after nasal allergen challenge correlate with clinical symptoms especially with regard to the "late allergic response," which occurs in approximately 40% to 50% of patients with allergy. OBJECTIVE: We sought to characterize the immunologic and clinical nasal responses to birch pollen allergen challenge with a special focus on the late allergic response. METHODS: In this randomized, double-blind, placebo-controlled trial, birch pollen-allergic participants were challenged with birch pollen extract (n = 20) or placebo (n = 10) on 3 consecutive days. On days 1 and 3, nasal secretions were collected at selected time points over a 24-hour time course for the measurement of 33 inflammatory mediators. Clinical responses were determined through subjective symptom scores and objective nasal airflow measurements. RESULTS: Provoked participants had significantly greater clinical responses and showed significant increases in tryptase and the soluble IL-33 receptor serum stimulation 2 (sST2) in nasal secretions within minutes compared with the placebo group. Eight of 20 provoked participants displayed high IL-13 levels 2 to 8 hours after allergen provocation. This group also showed significant changes in clinical parameters, with a secondary drop in nasal airflow measured by peak nasal inspiratory flow and increased symptoms of nasal obstruction, which significantly differed from IL-13 nonresponders after 6 hours. CONCLUSIONS: IL-13 response status correlates with clinical responses and type 2 cytokine responses in the late phase after allergen provocation.

Efficacy and safety of an oral formulation of cetirizine and prolonged-release pseudoephedrine versus budesonide nasal spray in the management of nasal congestion in allergic rhinitis.

INTRODUCTION: The aim of this study was to compare the decongestant properties and tolerability of oral cetirizine and pseudoephedrine in a prolonged release form with those of nasal (aqueous spray) budesonide. METHODS: Thirty-six individuals experiencing allergic rhinitis to house dustmites (HDM) participated in a study according to a randomized, crossover, two-period, two-treatment design with at least a 2-week washout period between treatments. In each period of 4 consecutive days, medications were taken twice daily. On day 1, immediately after the first intake of medication, individuals were exposed to HDM extract in the Vienna Challenge Chamber (VCC) for 5 hours. The primary efficacy parameter was nasal congestion, assessed by active anterior rhinomanometry and rating of nasal cavity photos. RESULTS: Rhinomanometry and nasal cavity photos both indicated that cetirizine/pseudoephedrine efficacy was statistically superior to budesonide in the management of nasal congestion during VCC sessions. The efficacy of cetirizine/pseudoephedrine was similar to that of budesonide from the end of day 1 up to day 4 when individuals were exposed to their natural environment post exposure to the aeroallergens. This study confirms the efficacy of cetirizine/pseudoephedrine and budesonide in the management of nasal congestion associated with allergic rhinitis. Both medications were well-tolerated. Cetirizine/pseudoephedrine was more effective than budesonide during HDM exposure, whereas budesonide became as effective as cetirizine/pseudoephedrine several hours post exposure to the allergens.

Computed tomography scans in the evaluation of patients with olfactory dysfunction.

BACKGROUND: The necessity of computed tomography (CT) scans of the olfactory cleft and the sinuses in patients presenting with olfactory dysfunction is a matter of debate. This study aimed to investigate the significance of CT scans for the diagnosis of olfactory loss and for therapeutic decisions. METHODS: This retrospective study included 137 consecutive patients presenting with the main complaint of olfactory loss. Standardized history; ear, nose, and throat examination; and olfactory tests were administered. In addition, a CT scan of the nasal sinuses was obtained. The assumed diagnosis (sinonasal disease [SND] or non-SND) was compared with the diagnosis when additionally considering results from the CT scan. RESULTS: CT scans suggested SND in 7/101 patients, without clinical evidence of its presence. In 12/36 patients with suspected SND-related olfactory loss, no signs of SND were detected in CT scans. CONCLUSION: CT scans are useful to diagnose conductive/inflammatory olfactory loss in patients suspected of non-SND, which may then justify a course with systemic steroids. Alternatively, considering low costs and rare side effects of a short course with steroids in selected patients, CT scans appear to be of clinical significance only when surgical treatment is contemplated or where the use of systemic corticosteroids is not possible.