The prevalence of high risk of obstructive sleep apnea in patients with allergic rhinitis.

BACKGROUND: Although allergic rhinitis (AR) has not been acknowledged as a strong risk factor for obstructive sleep apnea (OSA), several pathophysiological linkages between these two conditions have frequently been reported. However, epidemiological data relating to the prevalence of OSA in patients with AR remain scarce. OBJECTIVE: To investigate the prevalence of patients at high risk for OSA among patients with AR, and to determine the relationship between OSA and severity of AR. METHODS: Patients aged ≥ 18 years with a diagnosis of AR and positive skin prick test were recruited from the allergy clinic, Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand between October 2014 to November 2015. During routine follow-up, participants were asked to complete the STOP-Bang questionnaire and visual analog scale regarding AR symptoms, including their duration and severity. Patients with STOP-Bang score of ≥ 3 were considered as high risk for having OSA. RESULTS: Of the 120 AR patients (45 males, 75 females) included, there were 28 patients (19 males, 9 females) who had a STOP-Bang score of ≥ 3 (23.3%), especially for those who had longer duration of AR symptoms (low-risk/high-risk: 60/120 months, p = 0.01). However, no significant relationship was observed between ARIA classification and severity of nasal symptoms of AR for being high risk of OSA. CONCLUSIONS: The prevalence of high risk of having OSA in patients with AR was two times higher than that in general Thai population. Early screening and further management for these patients may improve treatment outcomes and quality of life.

Prevalence of nasal carriage of Staphylococcus aureus in allergic rhinitis patients and healthy controls in Thailand.

BACKGROUND: Staphylococcus aureus has been proposed as a disease modifier of allergic rhinitis (AR) severity. Although several studies have investigated the prevalence of nasal carriage of S. aureus in healthy controls and AR patients, data from Thailand is scarce. OBJECTIVE: The aim of this study was to determine the prevalence of nasal carriage of S. aureus in AR patients compared with healthy controls in Thailand. METHODS: This prospective study enrolled non-AR healthy controls and confirmed AR aged 18-60 years who attended the Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during June 2013 and December 2013. To detect nasal carriage of S. aureus, nasal swab was used for specimen collection from the nasal vestibule. S. aureus prevalence was compared between groups. All AR patients were assessed for disease severity and quality of life. RESULTS: The 200 enrolled participants were evenly divided between the AR and healthy control groups. Nasal swab cultures were positive for S. aureus in 20 of 100 subjects in the healthy control group, and in 21 of 100 subjects in the AR group (p = 0.86). Nasal carriage of S. aureus was significantly more prevalent in males than in females (p = 0.01). None of the investigated factors were found to be significantly associated with AR severity among S. aureus-positive AR subjects. CONCLUSIONS: The 20% prevalence of S. aureus in AR patients is not different from that of healthy controls in Thailand, and is similar to other reported rates. No significant associations with AR severity were identified.

Pattern of allergic sensitization in chronic rhinitis: A 19-year retrospective study.

BACKGROUND: The pattern of allergic sensitization provides data for physicians to take appropriate care of allergic patients. OBJECTIVE: To analyze the long-term pattern of allergen skin prick test (SPT) sensitization at a single tertiary care hospital in Thailand. METHODS: Medical records of adult rhinitis patients during 1998 to 2017 were reviewed. Inclusion criteria were chronic rhinitis with positive SPT to at least one aeroallergen in the test panel. Outcome measures were SPT results, clinical symptoms, and their effect on patient quality of life (QoL). Descriptive statistics were used to demonstrate the pattern of sensitization. Multivariate linear regression was used to identify association between evaluated factors and patient QoL. RESULTS: Six thousand five hundred and seventeen adult patients were included in this study. Mean age was 36.4 & 13.8 years. A majority of patients (59.4%) had positive SPT, and 83.7% of those had polysensitization. Dermatophagoides pteronyssinus and sedge were the most common indoor (54.8%) and outdoor allergens (37.7%), respectively. Compared among the various periods of data collection over a 19-year period, there was no major change in the pattern of sensitization. Considering the most recent data from 2013-2017, the prevalence of sensitization increased from 66.8% to 73.7% (p < 0.001). Clinical symptoms, except sneezing and allergen sensitization, affect QoL of chronic rhinitis patients (p < 0.001). CONCLUSIONS: House dust mite and sedge are the most common indoor and outdoor allergens. There was no major change in the pattern of sensitization. Almost all allergic symptoms significantly affect QoL.

Minimal clinically important difference for the rhinoconjunctivitis quality of life questionnaire in allergic rhinitis in Thai population.

BACKGROUND: Clinical measurement of the severity of allergic rhinitis (AR) can be assessed by symptoms score and patient quality of life (QoL). The magnitude of change in both symptoms and patient QoL should be considered in the management of AR. OBJECTIVE: The aim of this study was to determine the minimal clinically important difference (MCID) in AR in Thai population. METHODS: This prospective study recruited AR patients that attended our clinic during September 2011 to February 2012. The Rhinoconjunctivitis Quality of Life (Rcq-36) questionnaire was used to evaluate patient QoL. The Global Rating of Change Scale (GRCS) was used to assess improvement or deterioration in condition. The MCID was determined using an anchor-based method based on the GRCS, which was compared to the MCID determined by a distribution-based method based on the standard deviation (SD). RESULTS: Three hundred seventy-two patients with chronic rhinitis were recruited. Eighty-four of those had positive skin prick test and be diagnosed as AR. Of those, 79 completed the study and were included in the final analysis. A change of 2 points on the GRCS yielded an MCID for overall QoL of 0.21 ± 0.57. When applying the distribution-based method, an SD of 1.5 SD yielded an MCID for QoL of 0.27. For the rhinitis symptoms domain, the MCID was 0.42 ± 0.72. CONCLUSIONS: The MCID for overall QoL and rhinitis symptoms in Thai AR patients was found to be 0.21 ± 0.57 and 0.42 ± 0.72, respectively. MCID can be applied for determining the clinical significance of treatment efficacy in AR.

Concordance of skin prick test and serum-specific IgE to locally produced component-resolved diagnostics for cockroach allergy.

BACKGROUND: Diagnosis of Periplaneta americana (American cockroach, ACR) allergy is commonly performed based on clinical history and skin prick test (SPT) or specific serum IgE (sIgE) measurement. The concordance of the findings with the SPT and sIgE results has never been investigated. OBJECTIVE: To compare the results of SPT with commercial ACR-extract (C-ACE) and sIgE measurement, using commercial kit and in-house enzyme-linked immunosorbent assay (ELISA) to the locally produced ACR extract (L-ACE) and native Per a 1, Per a 5, Per a 7, and Per a 9. METHODS: Sera from 66 individuals clinically diagnosed with chronic allergic rhinitis were included; 46 were positive SPT to C-ACE, and 20 were negative. Specific serum IgE levels were established by using a commercial test kit (ImmunoCap) and an in-house IgE-ELISA RESULTS: The percentage the C-ACE SPT-positive cases that were positive by the ImmunoCap-sIgE was 32.6%, indicating low concordance of the 2 assays. With the in-house ELISA, Per a 9 gave the highest sensitivity (98.00%), positive predictive value (PPV; 95.74%), and negative predictive value (NPV; 94.74%) of the sIgE quantification. The correlation coefficients (R) of the L-ACE-SPT and sIgE to L-ACE, Per a 1, Per a 5, Per a 7, and Per a 9 and ImmunoCap sIgE were 0.133, 0.278, 0.419, 0.280, and 0.432, and 0.256, respectively. CONCLUSION: Skin prick test and sIgE measurement using commercial reagents have low concordance. Data of this study showed that sIgE to the native Per a 9 should be considered as an adjunct to the clinical history in diagnosis of ACR sensitization/allergy, particularly when the SPT and the nasal challenge, which is the gold standard method, cannot be performed.

Glutathione S-transferase (GST) of American Cockroach, Periplaneta americana: Classes, Isoforms, and Allergenicity.

Insect glutathione S-transferases (GSTs) play important roles in insecticide/drug resistance and stress response. Medically, GSTs of house dust mites (Dermatophagoides pteronyssinus and Blomia tropicalis) and German cockroach (Blattella germanica) are human allergens. In this study, classes, isoforms and B-cell and allergenic epitopes of GST of American cockroach, Periplaneta americana, the predominant species in the tropics and subtropics were investigated for the first time. Enzymatically active native and recombinant P. americana-GSTs bound to IgE in sera of all P. americana allergic patients that were tested. By gel-based proteomics and multiple sequence alignments, the native GST comprises three isoforms of delta and sigma classes. All isoforms interacted with serum IgE of the cockroach allergic subjects. Molecularly, the protein contains six B-cell epitopes; two epitopes located at ß1-α1 and ß4-α3 regions bound to patients' serum IgE, indicating that they are allergenic. P. americana are ubiquitous and their GST can sensitize humans to allergic diseases; thus, the protein should be included in the allergen array for component resolved diagnosis (CRD) of allergic patients, either by skin prick test or specific IgE determination. The GST is suitable also as a target of environmental allergen detection and quantification for intervention of cockroach sensitization and allergic morbidity.

Comparison of the efficacy and safety of pollen allergen extracts using skin prick testing and serum specific IgE as references.

BACKGROUND: Allergen extracts may be different due to the difference in dissemination of allergen-containing species in various geographical areas. Therefore, we wish to develop our own extracts to ensure the precision and quality of diagnosis. OBJECTIVES: To compare the efficacy and safety of our locally prepared pollen allergen extracts to imported ones, using skin prick testing (SPT) and serum specific IgE (sIgE) as references. METHODS: This prospective, randomized, double-blinded, self-controlled study was performed in respiratory allergic adult volunteers who are sensitized to at least one kind of pollen. Each subject was pricked with our Bermuda grass, Johnson grass and careless weed pollen allergen extracts, and also with the imported ones. sIgE levels were measured by using ImmunoCAP?. RESULTS: In 68 volunteers, our Bermuda, Johnson and careless weed extracts showed 91.2%, 45.6% and 54.4% positive SPTs, respectively, while for the imported ones 73.5%, 45.6% and 54.4% SPTs were positive, respectively. No adverse reaction was found in all procedures. The concentration of 10,000 BAU/mL of Bermuda grass, 1 : 20 w/v or 10,000 PNU/mL of Johnson grass and 1 : 40 w/v or 10,000 PNU/mL of careless weed yielded the most positive SPT results. There was no significant difference in mean wheal diameter (MWD) yielded from using local and imported extracts. Significant correlation was found between MWDs of imported pollen extracts and serum sIgE levels (p < 0.01). CONCLUSIONS: No significant difference between SPT results of local and imported pollen allergen extracts was found. Significant correlation was found between MWDs of imported pollen extract SPT and serum sIgE levels.

Erratum to: Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement.

[This corrects the article DOI: 10.1186/s40413-016-0122-3.].

Comparison between specific IgE levels and skin prick test results of local and imported American cockroach, dog, cat, dust mites and mold allergen extracts.

BACKGROUND: Skin prick test (SPT) and specific IgE (sIgE) are approved for evaluation of allergen sensitization. Local allergen extracts are less expensive and more available but need to be standardized. OBJECTIVE: To compare SPT results of local and imported allergen extracts and sIgE levels in response to the American cockroach, dog, cat, Dermatophagoides pteronyssinus (Dp), Dermatophagoides farinae (Df) and Cladosporium spp. allergens. METHOD: This prospective, randomized, double-blind, self-controlled study was performed in respiratory allergic volunteers. Each subject was pricked with local and imported allergen extracts and sIgE levels were measured. RESULTS: The agreement between SPT results from each local and imported allergen extract was statistically significant, and the level of agreement for dog allergens was very good (kappa > 0.8). All patients with a positive SPT in response to imported Dp allergen extract had positive SPT in response to local Dp allergen extract. Mean wheal diameter of each allergen in both groups showed significant correlation with sIgE levels. The correlation coefficient (CC) for cat allergens showed a very good-to-excellent relationship (CC> 0.75). When compared with sIgE levels, SPT results for imported and local allergen extracts showed comparable sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio (LR)+ and LR-. CONCLUSIONS: When the SPT results are compared between local and imported allergen extracts, all were found to have significant agreement, with very good agreement for cat allergens. When the SPT results are compared with specific IgE levels, both local and imported allergen extract provided comparable validity.

Reliability and validity study of Sino-nasal outcome test 22 (Thai version) in chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) is one of common health conditions that affects patients' health-related quality of life. Our purpose is to assess the reliability and validity of Thai-version of Sino-Nasal Outcome Test 22 in chronic rhinosinusitis. METHODS: Permission for translation of SNOT-22 from English language to Thai language was obtained from the developer. The translation process was done based on the international standard of translation method. A total of 80 subjects were recruited into the study and divided into two groups comprising of 50 patients with chronic rhinosinusitis and 30 healthy volunteers. Cronbach's α and Intraclass correlation coefficient were evaluated for its reliability. Validity test was evaluated against VAS score, SF-36 (Thai version) questionnaire and CT scan (based on Lund-Mackay score). Responsiveness was assessed between pre-operative and post-operative scores in 34 patients. RESULTS: The Thai version of SNOT-22 showed good reliability according to high value of Cronbach's α coefficient (r = 0.929) and intraclass correlation coefficient (r = 0.935). It also showed good validity by its ability to differential the patients with chronic rhinosinusitis from normal (p < 0.001), and different severity of symptoms (p < 0.05). In addition, the SNOT-22 Thai version also showed good responsiveness when compared between pre-operative and post-operative scores (p < 0.001) and also well-performed in effect size calculation (1.37). CONCLUSION: We demonstrated that Thai -version of SNOT-22 has good reliability and validity, suitable for evaluation of chronic rhinosinusitis symptoms together with severity of the disease and response to treatment. TRIAL REGISTRATION: Thai clinical trials registry TCTR20170320003. Date of registration 20/03/2017 (retrospectively registered).

Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement.

One of the major concerns in the practice of allergy is related to the safety of procedures for the diagnosis and treatment of allergic disease. Management (diagnosis and treatment) of hypersensitivity disorders involves often intentional exposure to potentially allergenic substances (during skin testing), deliberate induction in the office of allergic symptoms to offending compounds (provocation tests) or intentional application of potentially dangerous substances (allergy vaccine) to sensitized patients. These situations may be associated with a significant risk of unwanted, excessive or even dangerous reactions, which in many instances cannot be completely avoided. However, adverse reactions can be minimized or even avoided if a physician is fully aware of potential risk and is prepared to appropriately handle the situation. Information on the risk of diagnostic and therapeutic procedures in allergic diseases has been accumulated in the medical literature for decades; however, except for allergen specific immunotherapy, it has never been presented in a systematic fashion. Up to now no single document addressed the risk of the most commonly used medical procedures in the allergy office nor attempted to present general requirements necessary to assure the safety of these procedures. Following review of available literature a group of allergy experts within the World Allergy Organization (WAO), representing various continents and areas of allergy expertise, presents this report on risk associated with diagnostic and therapeutic procedures in allergology and proposes a consensus on safety requirements for performing procedures in allergy offices. Optimal safety measures including appropriate location, type and required time of supervision, availability of safety equipment, access to specialized emergency services, etc. for various procedures have been recommended. This document should be useful for allergists with already established practices and experience as well as to other specialists taking care of patients with allergies.

Comparison of different local and imported histamine concentrations used as a skin prick test positive control.

BACKGROUND: The skin prick test (SPT) is a valid and approved tool that is used to diagnose atopic diseases. The SPT is accurate, safe, simple and inexpensive. However, the histamine concentration used as a positive control in the SPT varies among centers. OBJECTIVE: To compare SPT results using different concentrations of locally-prepared and imported histamine solutions. METHOD: This prospective, randomized, double-blind, self-controlled study was performed in healthy adult volunteers. The SPT was performed using 4 concentrations of histamine solutions (imported, 1 mg/mL; locally-prepared, 1, 5 and 10 mg/mL). Locally-prepared histamine positive controls were prepared from histamine biphosphate monohydrate using sterile technique. RESULTS: Seventy-five adult volunteers (mean age, 36 years) were included in the study. Eight volunteers were male and 9 had a history of atopy. Mean wheal diameter (MWD) for imported histamine was 3.49 mm for a concentration of 1 mg/mL, and that of locally-prepared histamine was 2.94 mm, 5.05 mm and 5.52 mm for concentrations of 1, 5 and 10 mg/mL histamine, respectively. Negative SPT results (MWD <3 mm) were found in 11 subjects (14.7%) who received imported histamine and 26 subjects (34.7%) who received the locally-prepared histamine at concentration of 1 mg/mL. All subjects tested with locally-prepared histamine at concentrations of 5 and 10 mg/mL had a MWD > 3 mm. CONCLUSIONS: Locally-prepared histamine base at concentrations of 5 and 10 mg/mL yielded better positive results than both imported and locally-prepared histamine at a concentration of 1 mg/mL.

The correlation between intradermal testing and serum specific IgE to house dust mite in negative skin prick test allergic rhinitis adult patients.

BACKGROUND: Diagnosis of allergic rhinitis (AR) is based on history, physical examination, and skin prick test (SPT) while intradermal (ID) test can be performed to confirm the diagnosis in case of negative result of SPT. However, the ID test is not recommended for cat and timothy grass allergy because of its high false positive rate. As a result, the "quantitative" technique of serum specific IgE (sIgE) measurement might be helpful to diagnose AR with more confidence. OBJECTIVES: To evaluate the correlation between ID tests and sIgE in the diagnosis of house dust mite (HDM)-sensitive AR patients. METHODS: Patients with chronic rhinitis (CR) were recruited and SPT was performed. If SPT was negative, ID test and sIgE to HDM [Dermatophagoides pteronyssinus (Dp)] measurement were performed. RESULTS: Eighty-two patients with chronic rhinitis (CR), whose SPTs were negative for Dp, were included. There were 39 males (47.6%) and 43 females (52.4%) aged between 18 and 76 years old (mean age = 43.3 years). The ID test was positive in 13 patients (15.9%), and was negative in 69 patients (84.1 %). sIgE to HDM was positive ( ≥ 0.35 kUA/l) in 2 patients (2.4%). There was a fair to moderate correlation between the size of wheal of ID test and sIgE to HDM (r = 0.44, 95% confidence interval: 0.19 to 0.67, p < 0.01). CONCLUSION: ID test has a fair to moderate correlation with sIgE Dermatophagoides pteronyssinus and it can be used in CR patients with negative SPT where sIgE is not feasible.

Airborne pollen survey in Bangkok, Thailand: A 35-year update.

BACKGROUND: Pollen allergy is a growing global health issue. While airborne pollen counts are reported daily in several countries, such information is lacking in Thailand. OBJECTIVE: This study aimed to survey airborne pollens at five sites in Bangkok, comparing data with the previous study performed 35 years ago in 1980. METHODS: Sample collection was done using the ROTOROD® sampler by exposing the rods for one hour each day twice a week from May 2012-April 2013. RESULTS: Overall, we found that the average pollen count was relatively high throughout the year, at an average of 242 grains/m3. The highest peak was found in September (700 grains/m3). Interestingly, we found that the pollen count was noticeably lower in 2012-2013 when compared to the 1980 study. We also observed the approximate shift of pollen peaks about one to two months earlier in the 2012-2013 study. However, the major groups of airborne pollens did not change significantly. Grass, sedge, amaranthus pollens and fern spores still dominated. The unidentified pollen group was the only group with a higher pollen count when compared to the previous study.

A randomized study of temperature-controlled versus bipolar radiofrequency for inferior turbinate reduction.

UNLABELLED: The objective of this study is to compare outcomes of temperature-controlled radiofrequency (TCRF) and bipolar radiofrequency (BRF) for inferior turbinate reduction in patients with chronic rhinitis (CR). This was a prospective, randomized non-inferiority trial. Eighty-four adult patients with CR refractory to medication were randomized into two intervention groups: TCRF(42) or BRF(42). Primary outcomes consisted of patient-orientated visual analog scale (VAS; 0-10) of nasal obstruction at 4th postoperative week. Secondary subjective outcomes included VAS of nasal discharge, sneezing, hyposmia, and postnasal drip. Objective outcomes included crusting, mucociliary transportation time, minimal cross-sectional area, total nasal volume, and nasal airway resistance performed by blind assessors before and at 4th postoperative week and 1-year follow-up. Baseline and perioperative data showed no statistically significant difference between both groups, except for longer operative time in TCRF (481.5 ± 36.2 vs. 37.1 ± 3.0 s, p < 0.001) and slightly more crusts in BRF group (p = 0.04). Both intention-to-treat and per-protocol analyses, TCRF(39) versus BRF(41), revealed no significant difference among subjective and objective outcomes between two groups at 4th postoperative week. The 95% confidence intervals of mean differences of VAS scores of all subjective symptoms were within defined margin (-1.5 to 1.5), except for nasal discharge. At 1-year follow-up, there was still no significant difference in the outcomes. Minimal pain and minor bleeding without serious adverse effects from both interventions were reported. Both BRF and TCRF resulted in similar short-term outcomes, while less operative time was found in BRF group. Further studies, particularly, on cost-effectiveness should be conducted for better treatment selection. LEVEL OF EVIDENCE: 1b.

A Surveillance Bacteriological Study of Acute Bacterial Rhinosinusitis in Thailand and the Clinical Responses to the Culture-directed Antibiotics.

OBJECTIVE: To examine: 1) types of bacteria and antimicrobial sensitivity of commonly used antibiotics for acute bacterial rhinosinusitis (ABRS) in Thailand, 2) the effectiveness of using antibiotics according to antimicrobial sensitivity, and 3) the effectiveness of using antibiotics according to the Thai clinical practice guidelines (CPG) of ABRS. MATERIAL AND METHOD: Descriptive & experimental studies were conducted in seven tertiary hospitals in Thailand. The specimens from maxillary sinuses were taken for bacterial cultures either by maxillary sinus tap or endoscopically directed middle meatus swabs in patients with clinically diagnosed ABRS. Antimicrobial sensitivity was performed and antibiotics were prescribed according to the results of antimicrobial sensitivity or the Thai CPG of ABRS. RESULTS: A total of 113 patients were enrolled between August 2006 and April 2007, 104 cases of which were performed for bacteriological study. The incidence of bacterial growth was 60.6% (95% CI 51.0-69.4%). The most common bacteria was H. influenzae (25.0%, 95% CI 16.9-35.3%), followed by S. pneumoniae (14.3%, 95% CI 8.2-23.5%) and S. aureus (9.5%, 95% CI 4.7-17.9%), respectively, whilst M. catarrhalis was found only in 2.4% (95% CI 0.5-7.3%). Eight in 12 S. pneumoniae isolates were tested for the minimal inhibitory concentration of penicillin and found to be penicillin resistant strain in five specimens. Beta-lactamase producing H. influenzae was found in eight out of 20 isolates. H. influenzae had a tendency to be sensitive to amoxicillin/clavulanate, cefuroxime, cefpodoxime, azithromycin, clarithromycin, ofloxacin, levofloxacin and gatifloxacin, whilst S. pneumoniae had a tendency to be sensitive to amoxicillin/clavulanate, cefaclor ampicillin/sulbactam, cefuroxime, ofloxacin, levofloxacin, gatifloxacin, cefpodoxime, cefixime and cefdinir. The effectiveness of antibiotics prescription according to the Thai CPG of ABRS and antimicrobial sensitivity were comparable, 88.5% (95% CI 69.8-97.6%) and 82.2% (95% CI 67.9-92%), respectively. CONCLUSION: H. influenzae is found to be the most common bacteria in Thai ABRS, followed by S. pneumoniae and S. aureus. There is a high incidence of beta-lactamase producing H. influenzae and penicillin non-susceptible S. pneumoniae.

ICON: chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a public health problem that has a significant socio-economic impact. Moreover, the complexity of this disease due to its heterogeneous nature based on the underlying pathophysiology - leading to different disease variants - further complicates our understanding and directions for the most appropriate targeted treatment strategies. Several International/national guidelines/position papers and/or consensus documents are available that present the current knowledge and treatment strategies for CRS. Yet there are many challenges to the management of CRS especially in the case of the more severe and refractory forms of disease. Therefore, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), a collaboration between EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus (ICON) on Chronic Rhinosinusitis. The purpose of this ICON on CRS is to highlight the key common messages from the existing guidelines, the differences in recommendations as well as the gaps in our current knowledge of CRS, thus providing a concise reference. In this document we discuss the definition of the disease, its relevance, pharmacoeconomics, pathophysiology, phenotypes and endotypes, genetics and risk factors, natural history and co-morbidities as well as clinical manifestations and treatment options in both adults and children comprising pharmacotherapy, surgical interventions and more recent biological approaches. Finally, we have also highlighted the unmet needs that wait to be addressed through future research.

Radiofrequency inferior turbinate reduction improves smell ability of patients with chronic rhinitis and inferior turbinate hypertrophy.

Radiofrequency inferior turbinate reduction (RFITR) of inferior turbinate hypertrophy (ITH) is an effective way to treat patients with intractable nasal mucosal obstruction. The objective of this study was to assess smell ability, nasal symptoms, inferior turbinate grading (ITG), peak nasal inspiratory flow (PNIF) of patients with chronic rhinitis (CR), and ITH before and after RFITR. Patients with CR and ITH, aged 18-60 years, who underwent RFITR, were prospectively recruited. Smell ability (measured by smell detection threshold [SDT]), visual analog scale (VAS) of nasal symptoms, ITG, and PNIF before and 6-10 weeks after RFITR were compared. Forty-eight subjects were included. All nasal symptoms were significantly decreased after RFITR. After surgery, SDT (tested by phenyl ethyl alcohol) was worsened in 7 patients (14.6%), improved in 8 patients (16.7%), and did not change in 33 patients (68.7%). SDT after RFITR of six patients in the worsened SDT group were still within normal range (> -6.5). There was only one patient whose SDT changed from normosmia to mild hyposmia (-7.25 to -5.38). In the improved SDT group, two of eight patients had obviously better SDT after RFITR, which changed from moderate hyposmia to normosmia (-3.65 to -10; -3.73 to -10), whereas six of eight patients had little better SDT after RFITR. RFITR also significantly reduced ITG and improved PNIF. In conclusion, the treatment of patients with CR and ITH with RFITR significantly improved PNIF, ITG, and nasal symptoms assessed by VAS, although SDT after RFITR could be the same or improved or worsened.

Prevalence of chronic rhinitis in Thai patients with obstructive sleep disordered breathing.

OBJECTIVE: To prospectively identify the prevalence of chronic rhinitis (CR) and findings from objective nasal airway evaluation in Thai patients with obstructive sleep disordered breathing (OSDB) in a sleep clinic. MATERIAL AND METHOD: Seventy patients, 44 males and 26females, with OSDB were recruited. All were asked to complete Epworth sleepiness scale (ESS), questionnaires regarding nasal symptoms including scores to assess the severity of CR, and objective nasal airway measurements. Nasal airway resistance (NAR) was measured by active anterior rhinomanometry and nasal volume and minimal cross-sectional area (MCA) were measured by acoustic rhinometry (before topical decongestion). RESULTS: Fifty-nine patients (84.3%) had a history of nasal obstruction, rhinorrhea, sneezing, and itching of either intermittent or persistent pattern, regardless of severity, for more than one month. Forty-six patients (65.7%) had active symptom of nasal obstruction. About 23% of patients had NAR higher than and 33% had MCA lower than 1 SD from the mean of normative values in healthy Asians. Both subjective and objective nasal parameters did not have a statistically significant correlation with the scores of ESS. CONCLUSION: A substantial proportion of patients with OSDB in the sleep clinic had co-existing CR symptoms and a tendency to be abnormal in objective nasal parameters when compared to general population. Careful history recording and a thorough evaluation of the nasal airway are, therefore, essential in these patients.

Inflammatory patterns in upper airway disease in the same geographical area may change over time.

BACKGROUND: Inflammatory patterns of nasal polyps (NPs) may vary. Changes over time have not been investigated so far. This study was designed to evaluate the inflammatory patterns of NPs in Thailand at two time points 12 years apart, explore differences in Staphylococcus aureus (SA) mucosal carriage rates over time, and the latter's relationship with the inflammatory patterns. METHODS: Formalin-fixed nasal tissue was obtained from 89 (47 in 1999 and 42 in 2011) patients suffering from chronic rhinosinusitis with NPs (CRSwNPs). Tissues were evaluated for eosinophils, neutrophils, IgE(+) cells, IgE and macrophage mannose receptors, interleukin (IL)-5 and IL-17 cytokine profile, and the presence of SA, using automated immunohistochemistry and peptide nucleic acid-fluorescence in situ hybridization. RESULTS: We found a significant increase in the absolute values of eosinophils and IgE(+) cells in the 2011 CRSwNP tissue series compared with 1999 and a significant but smaller increase in neutrophils. Semiquantitative evaluation revealed significantly higher mean values of positive cells for all studied inflammatory markers in the 2011 group of patients, except for the high-affinity IgE receptor. This "eosinophilic shift" of inflammation was accompanied by higher SA carriage, as well as higher frequencies of SA invasion (54.8% versus 10.6%; p < 0.001) in the 2011 compared with 1999 subjects. Patients with asthma were more likely to have higher SA carriage rates compared with nonasthmatic patients. CONCLUSION: There was a shift from predominantly neutrophilic to eosinophilic CRSwNPs in Thai patients within 12 years, with an increase in various inflammatory markers including IgE, which is associated with an increase in intramucosal presence of SA.