Comparison of orally exhaled nitric oxide in allergic versus nonallergic rhinitis.

BACKGROUND: Fractional exhaled nitric oxide (FeNO), a well-known marker of airway inflammation, is rarely evaluated in rhinitis of different etiology. We aimed to compare the eNO levels in allergic rhinitis (AR) and nonallergic rhinitis (NAR) with/without asthma, as well as the contributing factors that interfere with elevated FeNO. METHODS: Patients were enrolled based on chronic nasal symptoms. Orally exhaled NO was measured with the single exhalation method at 50 mL/s. All subjects underwent a panel of tests: skin-prick tests, asthma control test, blood sampling, spirometry, and health-related quality-of-life questionnaires. RESULTS: The study group consisted of mainly women (130 women/41 men), with a mean age of 32.6 ± 13.2 years. AR was diagnosed in 122 (78.2%), NAR in 34 (21.8%), and 15 subjects were healthy controls. FeNO was insignificantly higher in patients with AR compared with patients with NAR and controls (32.2 parts per billion [ppb] versus 27 and 19.4 ppb), with no difference between genders. NAR + asthma had higher FeNO than those without asthma (40.5 ppb versus 14.9 ppb; p < 0.03), whereas accompanying asthma did not affect FeNO levels in the AR group. AR ± asthma had significantly higher FeNO levels than the NAR-only group (p < 0.01). Among AR + asthma, perennial sensitization caused higher FeNO levels than did seasonal allergens (48.5 ± 33.9 and 19.5 ± 13.6' p = 0.003), whereas FeNO was significantly higher during the allergen season. Nasally inhaled corticosteroids insignificantly reduced FeNO levels in all groups. Severity and seasonality of rhinitis, asthma, and ocular symptoms, but not gender, age, body mass index, Total IgE, forced expiratory volume in 1 second, and smoking, were associated with FeNO. CONCLUSION: Rhinitis and comorbid asthma are responsible for increased FeNO, irrespective of atopy. However, NAR without asthma may not be considered as a strong risk factor for airway inflammation.

(Un)Awareness of allergy.

BACKGROUND: Allergy is associated with considerable morbidity. OBJECTIVE: The aim of this multicenter study was to provide insight into allergy knowledge and perceptions among the population. METHODS: During the World Allergy Day, several allergy clinics conducted public meetings to encourage the awareness of and education in allergy. At the beginning, participants filled out a questionnaire to assess their knowledge about what is allergy and to determine by whom those symptoms are cared. RESULTS: A total of 256 participants (187 women/69 men, mean age, 31.2 ± 12.5 years) completed the survey. Of the 202 participants with symptoms, 58.9% had physician-diagnosed allergic disease. Among the 19 symptoms evaluated, 56.5% of the symptoms were recognized as related with allergy, and this increased in compliance with education level (r = +0.427; P < 0.001) but not with diagnosed allergy (P = 0.34). Sneezing was the most common symptom thought to be related with allergy-related symptom (77.5%), whereas loss of smell was the least one (37.9%). Participants were more likely to be cared by an allergologist (72.9%) followed by other specialties, when experiencing allergy. CONCLUSIONS: Increasing the awareness for allergic symptoms is the key not only for the diagnosis but also for the optimal treatment. Therefore, education is an important component of prevention and control of allergic diseases.

Allergic and nonallergic rhinitis: the threat for obstructive sleep apnea.

BACKGROUND: Although allergic rhinitis (AR) is accepted as a risk factor for obstructive sleep apnea syndrome (OSAS), the role of nonallergic rhinitis (NAR) is unknown. OBJECTIVE: To compare OSAS in patients with AR vs NAR. METHODS: We performed an observational study in 48 adults with AR and NAR that included a review of rhinitis and sleep symptoms, skin prick test results, self-administered questionnaire (Epworth Sleepiness Scale and 36-Item Short Form Health Survey) findings, and all-night polysomnography records. RESULTS: The most frequent sleep symptom was snoring. Patients with AR had a significantly longer sleep duration and better sleep efficiency than did those with NAR. Both groups had frequent arousals. OSAS was diagnosed in 36% of patients with AR and in 83% of those with NAR (P = .001). Severe OSAS existed only in the NAR group. NAR showed a high correlation with OSAS (odds ratio, 6.4) and with apneas (odds ratio, 0.2). Body mass index, sex, and coexisting asthma did not have any predictable effect on OSAS, but age was correlated with OSAS. The impairment in quality of life was similar in both groups. CONCLUSIONS: Both AR and NAR are risk factors for a high apnea-hypopnea index, and both can predispose to sleep apnea. However, NAR seems to have a greater risk according to impaired polysomnography results and higher Epworth Sleepiness Scale scores. Therefore, patients with rhinitis should be treated not only for nasal symptoms but also for a better quality of sleep.

Allergic and nonallergic rhinitis: can we find the differences/similarities between the two pictures?

The diagnostic challenge of rhinitis is to determine the etiology, specifically whether it is allergic or nonallergic. We therefore evaluated the general features of patients with allergic (AR) and nonallergic rhinitis (NAR), as well as health-related quality of life (HRQoL). The study group consisted of 323 patients (201 F/122 M) with a mean age of 31.79 +/- 12.64 years. Almost two thirds of the population had AR (63.5%). Neither the demographic characteristics nor the duration of rhinitis was different between the two groups. Total immunoglobulin E was significantly higher in AR. Although both groups displayed a mild-intermittent rhinitis profile, patients with AR had more seasonal and NAR had more perennial symptoms (p = 0.01). Frequency of nasal obstruction was comparable in both groups, whereas patients with AR significantly complained of rhinorrhea (86.8%), followed by nasal obstruction, sneezing, and nasal itching compared with the NAR group. Conjunctivitis and sinusitis were more prominent in the AR than NAR group (p = 0.01). However, the prevalences of asthma and bronchial hyperreactivity were not different, as well as the other allergic or systemic comorbidities. Furthermore, the impairment in HRQoL was similar in both groups, using a generic questionnaire- Short form-36 (SF-36). In conclusion, although the allergy test results still remain the only relevant difference, the diagnosis of NAR is important as it has many differences/similarities with AR and is seen almost half as often as AR in patients with chronic rhinitis.

Effect of body mass index on quality of life in allergic/asthmatic patients.

Evaluation of quality of life (QoL) is of particular interest in patients suffering from chronic diseases. Although studies have shown an association between QoL and obesity and allergy/asthma, the effect of obesity on QoL is not well known. The aim of this study was to assess the impact of body mass index (BMI) as a contributory factor on QoL in patients with a diagnostic label of allergy/asthma. We surveyed 100 patients (69 F/31 M) (age 34.15+/-13.32 years), and 65 healthy controls (42 F/23 M) (age 35.45 +/-8.96 years). QoL was determined by SF-36. BMI > or = 25 kg/m(2) was accepted as overweight/obesity. Forty-five percent of the patients had BMI > or = 25 kg/m(2) with no difference between the genders. They were significantly older and more likely to have less education level than those with BMI < 25 kg/m(2). Quality-of-life scores among patients with allergy/asthma were lower than those in the control group, irrespective of BMI. However, increased BMI was found to be related with improved quality of life among controls. Pearson's analysis showed that BMI was inversely correlated with physical functioning among patients (r = -0.229, p = 0.034), but in the control group it was positively correlated with QoL. All the domains of SF-36, except role-physical ones, among female subjects were significantly impaired more than those of male patients. It has been shown that the major determinants of impaired QoL are female sex, older age, and less educational status in patients with allergic/asthmatic symptoms. The impact of BMI on QoL could be undermined, because it seems to play a minor role.

A survey of acarofauna in Turkey: comparison of seven different geographic regions.

House-dust mites play an important role in allergic sensitization in Turkey and other countries. The purpose of this study was to analyze the acarofauna in seven zones that differ in climate and altitude. Dust mites were isolated in 173 of 930 (18.6%) samples. The highest prevalence of house-dust mites was found in the most humid regions of Turkey: Mediterranean (48.4%) and Black Sea (46%). Lower levels were found in central and eastern Anatolia regions where humidity and temperature are low. Mites of the Dermatophagoides spp. were predominant (D. pteronyssinus [83%] and D. farinae [12%] making up the majority of the counts). The presence of mites was related to an increase both in mean temperature (> 15 degrees C) and in humidity (> or = 40%) as well as low altitude (< 300 m). This study suggests that the mite population of humid coastal regions of Turkey is as prevalent as in other temperate climates.