Evidence of fatigue, disordered sleep and peripheral inflammation, but not increased brain TSPO expression, in seasonal allergy: A [11C]PBR28 PET study.

Allergy is associated with non-specific symptoms such as fatigue, sleep problems and impaired cognition. One explanation could be that the allergic inflammatory state includes activation of immune cells in the brain, but this hypothesis has not been tested in humans. The aim of the present study was therefore to investigate seasonal changes in the glial cell marker translocator protein (TSPO), and to relate this to peripheral inflammation, fatigue and sleep, in allergy. We examined 18 patients with severe seasonal allergy, and 13 healthy subjects in and out-of pollen season using positron emission tomography (n = 15/13) and the TSPO radioligand [11C]PBR28. In addition, TNF-α, IL-5, IL-6, IL-8 and IFN-γ were measured in peripheral blood, and subjective ratings of fatigue and sleepiness as well as objective and subjective sleep were investigated. No difference in levels of TSPO was seen between patients and healthy subjects, nor in relation to pollen season. However, allergic subjects displayed both increased fatigue, sleepiness and increased percentage of deep sleep, as well as increased levels of IL-5 and TNF-α during pollen season, compared to healthy subjects. Allergic subjects also had shorter total sleep time, regardless of season. In conclusion, allergic subjects are indicated to respond to allergen exposure during pollen season with a clear pattern of behavioral disruption and peripheral inflammatory activation, but not with changes in brain TSPO levels. This underscores a need for development and use of more specific markers to understand brain consequences of peripheral inflammation that will be applicable in human subjects.

Optical rhinometry - new challenges and possibilities of rhinitis diagnostics and not only.

Optical rhinometry is the only diagnostic tool in rhinitis for assessing real-time changes in nasal occlusion. It illustrates lumen changes of nasal mucosa vessels in response nonspecific/specific factors and not only. The first attempts to standardize the method conducted by German researchers show the potential of optical rhinometry not only as regards challenge tests, but also vice versa, in respect of the anemization of the mucosa it evaluates the extent of the oedema which occurred in the pathomechanism of non-allergic rhinitis. The relatively small number of publications in the domain of interest demonstrates there is a need to conduct further research on the suitability of the above-mentioned technique for the evaluation of nasal patency in the field of rhinological diagnostics.

Evaluation by (99m)Tc-pertechnetate scintigraphy of the effect of levocetirizine on salivary glands function, in allergic rhinitis patients.

The purpose of this study was to assess the effect of levocetirizine (xyzal) on salivary glands function in patients with allergic rhinitis using technetium-99m pertechnetate ((99m)Tc-P) salivary gland scintigraphy. The study population consisted of 67 patients with allergic rhinitis and 31 healthy controls (14 males and 17 females, mean age 30.1+/-6.8 years). The patients were divided into two groups: an untreated patient Group of 32 patients, 17 males and 15 females, mean age 29.9+/-6.5 years and a levocetirizine-treated with 5mg.day(-1) for 4 weeks patient Group, consisted of 35 patients, 16 males and 19 females, mean age 33.5+/-7.8 years. All patients and healthy controls underwent salivary glands scintigraphy. After the intravenous administration of 185 MBq of (99m)Tc-P, dynamic salivary glands scintigraphy was performed for 25 min. By the time-activity curves, the following glandular function parameters were calculated for the parotid and submandibular salivary glands: uptake ratio, maximum accumulation, and ejection fraction. Our results showed: All functional parameters obtained for the untreated patient Group were significantly lower than for the levocetirizine-treated patient Group and healthy controls (P<0.05). There was no significant difference in any functional parameters between the levocetirizine-treated patient Group and healthy controls (P>0.05). In conclusion, results of our study indicate that patients with allergic rhinitis treated with levocetirizine showed a significantly higher salivary glands function compared with untreated patients and healthy controls. Levocetirizine treatment showed no side effects on salivary glands function.

[Allergic rhinitis in childhood]. / La rhinite allergique de l'enfant.

Prevalence of allergic rhinitis has increased in the past years. The determination of the aeroallergens involved is important. Children with persistent rhinitis must be evaluated for asthma. Early treatment of allergic rhinitis may avoid asthma onset. The management of allergic rhinitis must include allergen avoidance, pharmacological treatment and immunotherapy. Sublingual swallow immunotherapy is a safe and effective method of treatment.

Subjects with allergic rhinitis show signs of more severely impaired paranasal sinus functioning during viral colds than nonallergic subjects.

BACKGROUND: Viral cold is thought to be the major contributing factor in the pathogenesis of sinusitis, as it causes ostiomeatal obstruction. The aim was to evaluate whether paranasal sinus functioning during viral colds is similar in subjects with and without allergic rhinitis. METHODS: Forty-eight volunteers were examined during an early (2-4 days) natural cold and again 3 weeks later. The examinations included computed tomography (CT) scans, nasal mucosal biopsies, and viral and bacterial specimens. Subjects with positive skin prick tests and persistent or intermittent rhinitis were considered to have allergic immunoglobulin E (IgE)-mediated rhinitis. In addition, specific IgE antibodies to staphylococcal enterotoxin B (SEB) were measured. RESULTS: Nine subjects (19%) had allergic rhinitis. The allergic subjects were significantly more often IgE sensitized to SEB than the nonallergic subjects (33%vs 3%, P = 0.02). Viral etiology of the cold was identified in 32 (67%) subjects. The subjects with allergic rhinitis had significantly higher CT scores compared with nonallergic subjects during the colds (median (range) scores 16 (6-22) vs 6 (0-17), P = 0.004). In both groups, the median scores declined markedly during convalescence, but the difference remained significant (P = 0.009). Among the allergic subjects, those who were IgE sensitized to SEB tended to have the highest CT scores [median (range) 16 (16-22)]. Total serum IgE and the nasal subepithelial eosinophil counts correlated with the CT scores during the cold (rs = 0.38, P = 0.008 and rs = 0.46, P = 0.001, respectively). CONCLUSIONS: Subjects with allergic IgE-mediated rhinitis had more severe paranasal sinus changes in CT scans than nonallergic subjects during viral colds. These changes indicate impaired sinus functioning and may increase the risk of bacterial sinusitis.

[Clinical study of the paranasal sinuses of patients with Japanese Cedar pollinosis].

To clarify paranasal sinus change in patients with Japanese cedar pollinosis, we studied reactions to medical treatment via X-ray images of patients during the 2000 cedar pollen season. Medication was administered to 577 patients consulting facilities in 3 regions--Kyoto, Fukui and Osaka--having different pollen counts i.e., 4555/cm2 in Fukui, 801/cm2 in Kyoto and 531/cm2 in Osaka. The paranasal sinus was X-rayed by Water's method, and the degree of positivity was classified by Katagiri'shadow classification. Patients were grouped into 334 suffering extensive Fukui pollen dispersion and 243 suffering relatively limited Kyoto and Osaka pollen dispersion. At 3-4 weeks after pollen dispersion, contrast shadow positivity was 22.2%, with no difference before pollen dispersion (22.2%) in Kyoto and Osaka. In Fukui, positivity was 39.7%, a clear increase over pre pollen dispersion (19.2%). In the initial treatment group, positivity was 25.8% in Fukui and 28.6% in Kyoto and Osaka. Our results suggest that the incidence of sinusitis in patients with Japanese cedar pollinosis tended to increase with exposure to extensive pollen dispersion and to be suppressed by initial treatment.

Objective measurement of nasal airway dimensions using acoustic rhinometry: methodological and clinical aspects.

INTRODUCTION: Nasal congestion is an important symptom in many diseases of the upper airways. Nasal congestion may also affect personal well-being and quality of life. Furthermore, as the nasal mucosa is the first part of the airways in contact with the environment, objective evaluation of nasal congestion or nasal patency is important. Systematic evaluation of nasal patency was described in the last part of the 19th century by Zwaardemaker. Measurement of the pressure drop over the nasal cavity at a passive dow has been described in 1903 by Courtade and is one of first descriptions rhinomanometry. The technique is still in use and computer technology has made the measurements much easier but the method has not yet been accepted for wide clinical use. METHODOLOGY: Acoustic methods have also been used for evaluation of nasal patency. A qualitative method was the hum-test by Spiess (1902), where external occlusion of the nonocciuded side of the nasal cavity is experienced as a change in the timbre of the sound during humming. Acoustic reflections have been used in geophysical investigations especially with regard to search for oil. The use of acoustic reflections from the airways gained special interest in 1960-70 for determining the geometry of the vocal tract shape with regard to speech reconstruction. A method described by A. Jackson (1977) was adopted and for the first time applied to the nasal cavity. The method for determining the cross-sectional area as function of distance in the airways by acoustic reflections is impulse or relatively simple. The incident sound pseudorandom noise in the audible frequency range is compared with the response - the reflections from the airways. Intuitively, if the size of the entrance to the airways is known, the size of the reflections may represent changes of the airway size and the time between reflections may give the distance between the changes, dependent on the speed of sound. In this way it is possible to determine the area as function of distance in the airways. The technique has some assumptions and the major effort has been to validate use in the nose and elucidate aspects with regard to sound loss in the airways and resolution. Therefore, the acoustic reflection technique - named acoustic rhinometry - was compared with other methods like MRI, CT, and rhinomanometry. Allergic and nonallergic subjects were also compared. RESULTS: Acoustic rhinometry showed reasonable correlation with CT in a cadaver and in 10 subjects in comparison with MRI for the first 6 cm of the nasal cavity. Models based on MRI scannings of subjects also showed good correlation for the first 6 cm of the nasal cavity. Posteriorly in the nasal cavity and the epipharynx, differences were found mainly due to 'sound loss' to the paranasal sinuses. Sound loss due to viscous loss or friction at increasing surface/area ratio (the complex geometry in the nose) and loss due to nonrigidity the nasal mucosa were also examined. Neither these factors affected the area-distance function significantly. Acoustic rhinometry seems to reflect the area-distance function in the nose reasonably accurately. In allergic subjects acoustic rhinometry has been used to evaluate hypersensitivity. More pronounced spontaneous variation in nasal mucosa congestion was found in patients suffering from hay fever compared to nonallergic subjects. Furthermore, a tendency to a more swollen mucosa in the allergic subjects compared to the normal state, and increased sensitivity to histamine was found. This and reduction in swelling of the mucosa in allergic subjects during nasal steroid treatment out of the pollen season indicate an ongoing inflammatory process or hypersensitivity in allergic subjects out ot the pollen season. During allergen challenge the change in nasal cavity dimension as well as inflammation may affect olfaction in hay fever patients. DISCUSSION: Acoustic rhinometry has not only been used to examine hay fever patients but in many different aspects of rhinology. Since the introduction of the acoustic reflection technique in the nose more than papers using the technique have been published. Most of the papers find the technique valuable for evaluation of nasal patency. Fortunately, some critical papers have drawn attention to some practical aspects of the technique. Standard operating procedures, and calibration checks as well as training operators will enhance the accuracy and reproducibility of results. CONCLUSION AND PERSPECTIVES: A decade after its introduction acoustic rhinometry is a well-established method for evaluation of nasal patency, but further improvement can be obtained by continued validation and adjustments of the technique.

Doppler echocardiographic evaluation of pulmonary arterial pressure in children with allergic rhinitis.

In children, persistent upper airway obstruction may lead to increased pulmonary arterial pressure (PAP). Allergic rhinitis (AR) is one of the frequent cause of persisting upper airway obstruction by nasal blockage in childhood. Regular use of nasal topical corticosteroids are effective in reducing nasal blockage and obstruction. However, whether symptomatic children with AR have increased PAP and curative effect of topical steroids are not known. The aims of this study were to clarify whether children having active symptoms of AR have increased PAP and to investigate the curative effect of reducing nasal obstruction by topical corticosteroids. Twenty-three children, aged between 5 and 16, diagnosed as AR, consisted of 17 seasonal AR (SAR) and seven perennial AR (PAR), were included in the study. Nineteen age and sex matched healthy children were received as controls. PAP was measured by using Doppler echocardiography in all subjects and symptom scores of AR were recorded in rhinitis group. After first evaluation, nasal steroid, budesonid, was given to rhinitis group for three months. Mean systolic PAP was 33.4+/-3.1 for children with AR mmHg and 23.6+/-4.3 mmHg for the control group. The difference was statistically significant (P<0.05). Mean systolic PAP of children with PAR was significantly higher than children with SAR (P<0.05). In rhinitis group, mean PAP decreased significantly after relief of upper airway obstruction by nasal corticosteroid therapy to normal level of 24.9+/-3.6 mmHg (P<0.05). Our results showed that children with AR may have significantly higher PAP than healthy subjects and decreased to normal levels after relieving nasal blockage by nasal corticosteroids. Nevertheless, Doppler echocardiography is a safe, non-invasive and practical tool for cardiac investigation of children with AR. Therefore, in symptomatic period, evaluation of PAP of children with AR by using Doppler echocardiography may be useful in the planning and following of their therapy.

Ragweed allergic rhinitis and the paranasal sinuses. A computed tomographic study.

OBJECTIVE: To explore the potential association of allergic rhinitis and sinusitis. DESIGN: Prospective clinical trial. SETTING: Academic tertiary referral center. PARTICIPANTS: Ten subjects with symptomatic ragweed allergy during the peak of the ragweed season. MAIN OUTCOME MEASURES: We obtained a paranasal sinus computed tomographic scan on all volunteers and had them complete a modified Rhinitis Quality of Life Questionnaire. All subjects were then treated with intranasal aqueous beclomethasone dipropionate (168 micrograms twice a day) and completed the Rhinitis Quality of Life Questionnaire weekly until the end of the study. RESULTS: Six of 10 of the subjects had sinus mucosal thickening on computed tomographic scan. All subjects improved symptomatically. A second computed tomographic scan was obtained after the pollen season in 5 patients with mucosal abnormalities, while the patients continued treatment with intranasal steroids and symptomatically improved. The sinus mucosal abnormalities persisted in all patients. CONCLUSION: Despite the 60% incidence of abnormalities on the computed tomographic scans of the subjects with ragweed allergy during the season, these abnormalities appear, at most, to contribute minimally to the patient's symptoms, since resolution of symptoms was not accompanied by a reduction in sinus mucosal abnormalities.

Caveat emptor: allergic rhinitis.

This case report illustrates that the typical symptoms of allergic rhinitis--rhinorrhea, itchy eyes, nose and throat--should not be taken as a routine phenomenon without consideration of other differential diagnoses. Caveat Emptor: "allergic rhinitis."

[Radiological appearance of the paranasal sinuses in allergic rhinitis. Apropos of 255 cases. Comparison between patients from urban and rural environments]. / Aspecto radiológico de los senos paranasales en la rinitis alérgica. A propósito de 255 casos. Comparación entre pacientes de ambiente urbano y rural.

The AA. consider the X-ray findings verified in 3 groups of subjects: with Hayfiber, with perennial rhinitis and the last one being a control group. The whole figure comprise as well urban or rural inhabitants. The conclusion drawn out is that more 50 per cent of allergic sufferers show radiologic evidences, especially the urban people, probably on account of the cities pollution.

Screening of allergic rhinitis.

The author, in an attempt to define the most suitable means for the preclinical diagnosis of allergic rhinopathy, submitted 1620 pupils from seven different state schools to examination. Their parents were asked to fill in a questionnaire through which 370 were considered to be "at risk". All children underwent scratch skin tests: 73 with positive skin reactions also underwent nasal examination, measurement of immunoglobulins in nasal secretion, rhinomanometry, nasal exposition tests, determination of blocking antibodies and radiological examination of the paranasal sinuses. RAST was carried out in 30 cases. After the analysis of the clinical data, the author came to the conclusion that the tests of nasal conductance and provocation, of mucociliary clearance and determination of blocking antibodies are adequate means for the long term study of allergic rhinitis and for the follow-up of contingent hyposensitization therapy. As far as the preclinical diagnosis is concerned the skin tests and the radiological examination of the paranasal sinuses are to be considered more specific than RAST which, in the population sample taken into consideration, was positive exclusively in those cases that already had a manifest symptom complex.