Effects of cleaning spray use on eyes, airways, and ergonomic load.

BACKGROUND: Cleaning workers are exposed to chemicals and high physical workload, commonly resulting in airway problems and pain. In this study the response in the upper airways and the physical workload following airborne and ergonomic exposure of cleaning spray was investigated. METHODS: A survey was answered by professional cleaning workers to investigate their use of cleaning sprays and the perceived effects on eyes, airways and musculoskeletal pain. A human chamber exposure study was then conducted with 11 professional cleaning workers and 8 non-professional cleaning workers to investigate the airborne exposure, acute effects on eyes and airways, and physical load during cleaning with sprays, foam application and microfiber cloths premoistened with water. All cleaning products used were bleach, chlorine, and ammonia free. The medical assessment included eye and airway parameters, inflammatory markers in blood and nasal lavage, as well as technical recordings of the physical workload. RESULTS: A high frequency of spray use (77%) was found among the 225 professional cleaning workers that answered the survey. Based on the survey, there was an eight times higher risk (p < 0.001) of self-experienced symptoms (including symptoms in the nose, eyes and throat, coughing or difficulty breathing) when they used sprays compared to when they cleaned with other methods. During the chamber study, when switching from spray to foam, the airborne particle and volatile organic compound (VOC) concentrations showed a decrease by 7 and 2.5 times, respectively. For the whole group, the peak nasal inspiratory flow decreased (-10.9 L/min, p = 0.01) during spray use compared to using only water-premoistened microfiber cloths. These effects were lower during foam use (-4.7 L/min, p = 0.19). The technical recordings showed a high physical workload regardless of cleaning with spray or with water. CONCLUSION: Switching from a spraying to a foaming nozzle decreases the exposure of both airborne particles and VOCs, and thereby reduces eye and airway effects, and does not increase the ergonomic load. If the use of cleaning products tested in this study, i.e. bleach, chlorine, and ammonia free, cannot be avoided, foam application is preferable to spray application to improve the occupational environment.

Lung function and self-rated symptoms in healthy volunteers after exposure to hydrotreated vegetable oil (HVO) exhaust with and without particles.

BACKGROUND: Diesel engine exhaust causes adverse health effects. Meanwhile, the impact of renewable diesel exhaust, such as hydrotreated vegetable oil (HVO), on human health is less known. Nineteen healthy volunteers were exposed to HVO exhaust for 3 h in a chamber with a double-blind, randomized setup. Exposure scenarios comprised of HVO exhaust from two modern non-road vehicles with 1) no aftertreatment system ('HVOPM+NOx' PM1: 93 µg m-3, EC: 54 µg m-3, NO: 3.4 ppm, NO2: 0.6 ppm), 2) an aftertreatment system containing a diesel oxidation catalyst and a diesel particulate filter ('HVONOx' PM1: ~ 1 µg m-3, NO: 2.0 ppm, NO2: 0.7 ppm) and 3) filtered air (FA) as control. The exposure concentrations were in line with current EU occupational exposure limits (OELs) of NO, NO2, formaldehyde, polycyclic aromatic hydrocarbons (PAHs), and the future OEL (2023) of elemental carbon (EC). The effect on nasal patency, pulmonary function, and self-rated symptoms were assessed. Calculated predicted lung deposition of HVO exhaust particles was compared to data from an earlier diesel exhaust study. RESULTS: The average total respiratory tract deposition of PM1 during HVOPM+NOx was 27 µg h-1. The estimated deposition fraction of HVO PM1 was 40-50% higher compared to diesel exhaust PM1 from an older vehicle (earlier study), due to smaller particle sizes of the HVOPM+NOx exhaust. Compared to FA, exposure to HVOPM+NOx and HVONOx caused higher incidence of self-reported symptoms (78%, 63%, respectively, vs. 28% for FA, p < 0.03). Especially, exposure to HVOPM+NOx showed 40-50% higher eye and throat irritation symptoms. Compared to FA, a decrement in nasal patency was found for the HVONOx exposures (- 18.1, 95% CI: - 27.3 to - 8.8 L min-1, p < 0.001), and for the HVOPM+NOx (- 7.4 (- 15.6 to 0.8) L min-1, p = 0.08). Overall, no clinically significant change was indicated in the pulmonary function tests (spirometry, peak expiratory flow, forced oscillation technique). CONCLUSION: Short-term exposure to HVO exhaust concentrations corresponding to EU OELs for one workday did not cause adverse pulmonary function changes in healthy subjects. However, an increase in self-rated mild irritation symptoms, and mild decrease in nasal patency after both HVO exposures, may indicate irritative effects from exposure to HVO exhaust from modern non-road vehicles, with and without aftertreatment systems.

Effectiveness of micronized nasal irrigations with hyaluronic acid/isotonic saline solution in non-polipoid chronic rhinosinusitis: A prospective, randomized, double-blind, controlled study.

BACKGROUND: Sodium hyaluronate has been proposed as a treatment for improving the symptoms of chronic rhinosinusitis. The present study evaluated the effect of the intranasal administration of hyaluronic acid in a group of patients affected by chronic rhinosinusitis without nasal polyps (CRSsNP). MATERIALS AND METHODS: Thirty subjects aged 18-65 years affected by CRSsNP were enrolled. The subjects were randomly administered hyaluronic acid or isotonic saline solution by nasal nebulizer twice per day for 30 days. They were evaluated before (T0) and after the treatment (T1) with Sino-Nasal Outcome Test-22, visual analogue scale for rhinorrhea, nasal obstruction, facial pain and hyposmia/hypogeusia, nasal endoscopy, active anterior rhinomanometry, peak nasal inspiratory flow and nasal cytology. RESULTS: Comparing the study and the control group, at T1 no significant differences were observed in both objective and subjective parameters. Being included in the study group rather than in the control group did not have a significant effect on the variation of the considered parameters between T0 and T1. Considering the effects of the micronized douches independently from the type of solution used (either hyaluronic acid or isotonic saline solution), although no difference emerged between study and control group for any of the objective parameters, there was an improvement of Sino-Nasal Outcome Test-22 scores (p = .0005), visual analogue scale for nasal obstruction (p = .0006) and for hyposmia/hypogeusia (p = .04). CONCLUSIONS: The treatment with micronized nasal douches can improve the sino-nasal symptoms of CRSsNP, in particular nasal obstruction and olfactory ability. No advantage of the use of hyaluronic acid over isotonic saline solution emerged.

Measuring Nasal Patency and the Sense of Smell in CRSwNP Patients Treated with Dupilumab.

Chronic rhinosinusitis with nasal polyps (CRSwNP) in the most severe forms is associated with a poor quality of life. Dupilumab has been suggested as an add-on treatment option for severe CRSwNP. Severe CRSwNP patients treated with dupilumab in different rhinological units were followed up at 1, 3, 6 and 12 months from the first administration and were considered for this study. At baseline (T0) and at each follow-up, patients underwent nasal endoscopy and completed the sinonasal outcome test (SNOT)-22, a visual analogue scale (VAS) for smell/nasal obstruction, peak nasal inspiratory flow (PNIF) and the Sniffin' Sticks identification test (SSIT). The aim of the present study was to evaluate the effects of dupilumab in patients with severe uncontrolled CRSwNP on recovering nasal obstruction and smell impairment. Moreover, the method between PNIF and SSIT with the highest correlation with patients' response to dupilumab was evaluated. One hundred forty-seven patients were included. All parameters improved during treatment (p < 0.001). At T0, no correlations were found between PNIF and nasal symptoms. Nevertheless, during the following evaluations significant correlations between PNIF changes and both nasal symptoms and NPS were observed (p < 0.05). At T0, SSIT did not correlate with SNOT-22. Similarly to PNIF, during the follow-up SSIT changes significantly correlated with nasal symptom and NPS (p < 0.05). Comparing PNIF and SSIT correlations with SNOT-22 and NPS, PNIF showed a higher correlation with both. Dupilumab improves nasal obstruction and the sense of smell. PNIF and SSIT are effective tools in monitoring patients' response to dupilumab.

Effectiveness of Dupilumab in the Treatment of Adult and Older Adult Patients with Severe, Uncontrolled CRSwNP.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial disease that significantly impacts patients' quality of life. New therapeutic strategies and in particular biologic treatments are now available for these patients. It has been demonstrated that Dupilumab (an anti IL-4/IL-13 biologic drug) is effective in reducing the size of nasal polyps and in improving patients' symptoms and thus, quality of life. No real-world studies examining Dupilamab's efficacy in the elderly with respect to other adult age groups have as yet been carried out. The aim of this multicentric study was to evaluate Dupilumab's efficacy in young-middle adults as opposed to an older adult population affected by severe, uncontrolled CRSwNP. Of the 96 patients included in the study, 22 were 65 years old or older. Significant improvements were observed in all the parameters considered in both age groups after treatment was begun (T0 mean values for SNOT-22 = 58.5 ± 20.3, VAS NO = 7.6 ± 2.2, VAS smell = 8.6 ± 2.1, NPS = 5.6 ± 1.4, PNIF = 101.6 ± 59.4, S'S = 5.1 ± 3.1), T4 mean values for SNOT-22 = 15.1 ± 12.7, VAS NO = 1.7 ± 1.8, VAS smell = 2.4 ± 3, NPS = 1.7 ± 1.7, PNIF = 162.4 ± 43.2, S'S = 10.4 ± 3.7) (p < 0.0001). No differences in the variables considered were observed between the two age groups during the study, with the exception of the Peak Nasal Inspiratory Flow (PNIF), which was marginally higher; this was also the case according to multivariate analyses (p = 0.008) in the young-middle adult group with respect to the elderly one (p = 0.07). At multivariate analyses, asthma and the female sex negatively influenced the PNIF values (p = 0.001 and p = 0.012, respectively). Age negatively influenced the Visual Analog Scale (VAS) for nasal obstruction (p = 0.0032) and Endoscopic Sinus Surgery (ESS) negatively influenced the patents' olfactory performance (p = 0.028) to the same degree in both groups. Dupilumab was found to be effective to the same degree in both age groups. It can be considered a safe and reliable option for the treatment of elderly patients with severe, uncontrolled CRSwNP.

Relationship Between Rhinitis, Nasal Obstruction and Hypothyroidism: A Follow Up Study with Pre-post Treatment with Levothyroxine.

Hypothyroidism is the most common form of thyroid disorder in India, while, Rhinitis and Nasal obstruction are frequent complaints treated on regular basis in ENT OPD. Studies show that there is relationship between Rhinitis and Nasal obstruction with hypothyroidism. To assess the improvement in symptoms associated with Rhinitis and nasal obstruction in patients with hypothyroidism after treating with levothyroxine. 50 patients presenting in ENT OPD with rhinitis and nasal obstruction and diagnosed with hypothyroidism were selected. Complete history was taken and clinical examination was performed, Nasal Obstruction Symptom Evaluation Score, (NOSE) and Peak nasal inspiratory flow rate (PNIF) were noted. Biochemically proven hypothyroid patients were treated with adequate dosage of Levothyroxine. The patients were followed up and the above-mentioned tests were repeated at regular intervals (1 month and 3 month), Changes in these readings were recorded and maintained. Significant difference was found in TSH level, NOSE questionnaire, and PNIF reading in patients with hypothyroidism after treatment with levothyroxine (P value < 0.001). This was most commonly noted to occur in young and middle-aged population of age 15 years to 50 years (88%). In our study - An attempt was made to correlate the symptomatology with hypothyroidism. Treatment with levothyroxine in patients with rhinitis, nasal obstruction and biochemically proven hypothyroidism was found to be effective in improvement of symptoms. It was found that there is significant association between hypothyroid status and rhinitis with nasal obstruction.

Objective and Subjective Analysis for Efficaciousness of Nasal Airway in Patients Undergoing Conventional and Endoscopic Septoplasty: A Comparative Study.

Deviated nasal septum is the most common cause of nasal obstruction and is one of the common problems encountered by otolaryngologists. Although there are different methods to surgically correct a deviated nasal septum which can give qualitative relief to the patient, less emphasis is put on the quantitative assessment of airway after a septal correction surgery. Institution based Case Control study was undertaken at Medical College and Hospital Kolkata between January 2019 to March 2020 to subjectively and objectively assess and compare the nasal airway status preoperatively and postoperatively in patients undergoing conventional and endoscopic septoplasty. A total of 250 patients were taken in this study and divided into two groups A and B. Group A consisted of patients undergoing Conventional Septoplasty (Control arm) and Group B consisted of patients undergoing Endoscopic Septoplasty (Case arm). Patients were followed up and the readings of NOSE score and PNIF value were recorded at the end of 6 weeks and 6 months (24 weeks). The Mean NOSE score post operatively at the end of 6 weeks was 36.32 in GROUP A (Control arm) and 33.08 in GROUP B (Case arm). t-Test revealed insignificant results with a p-value of 0.08. The mean NOSE score post operatively at the end of 6 months was 29.96 in GROUP A (Control arm) and 22.16 in GROUP B (Case arm). t-Test revealed significant results with a p-value of 0.00. Similarly, Mean PNIF value post operatively at the end of 6 weeks was 57.24 in GROUP A (Control arm) and 73.88 in GROUP B (Case arm). t-Test revealed significant results with p-value of 0.00. The mean PNIF value post-operatively at the end of 6 months was 59.44 in GROUP A (Control arm) and 80.08 in GROUP B (Case arm). t-Test revealed significant results with p-value of 0.00. Endoscopic Septoplasty is a very effective way to treat septal deviations especially with deviations based on the posterior aspect of the septum. It provides a superior edge in terms of nasal airway improvement as compared to conventional method of septoplasty. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03120-2.

Comparison of the Efficacy of Septoplasty with Nonsurgical Management in Improving Nasal Obstruction in Patients with Deviated Nasal Septum - A Randomized Clinical Trial.

Introduction In the current era, the major indication for septoplasty is nasal obstruction due to deviated nasal septum (DNS). Even though septoplasty is a commonly performed surgery, its effectiveness in relieving nasal obstruction in DNS has not been proven. Objective The present study involved the measurement of both objective (nasal patency) and subjective (quality of life measures) outcome measures for the evaluation of the efficacy of septoplasty as compared with medical management. Methods Patients with DNS presenting with nasal obstruction were included and randomized into a septoplasty group or into a nonsurgical management group, with 70 patients in each group. The improvement in nasal obstruction was assessed subjectively by the visual analogue scale (VAS), and the sino-nasal outcome test-22 (SNOT-22) and the nasal obstruction symptom evaluation (NOSE) questionnaires and was measured objectively by assessment of nasal patency by peak nasal inspiratory flow (PNIF) at 0, 1, 3, and 6 months of treatment in both groups. Results The average VAS, SNOT-22 and NOSE scores for the septoplasty versus the nonsurgical group before treatment were 6.28 versus 6.0, 19.5 versus 15, and 14 versus 12, respectively, and at 6 months post-treatment, the scores were 2.9 versus 5.26, 10 versus 12, and 8 versus 10 ( p = 0.001), respectively. The average PNIF scores at 0 and 6 months were 60/50 l/min and 70/60 l/min, respectively, in the septoplasty group ( p = 0.001); the scores at 0 and 6 months in the nonsurgical management group were 60/60 l/min and 70/70 l/min, respectively ( p = 0.001). Conclusion Surgical correction of DNS by septoplasty improves nasal obstruction better than nonsurgical management at 6 months postsurgery.

Effectiveness of Dupilumab in the Treatment of Patients with Uncontrolled Severe CRSwNP: A "Real-Life" Observational Study in Naïve and Post-Surgical Patients.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) represents 25−30% of all CRS cases, and in the most severe forms it is associated with a poor quality of life and a high rate of nasal polyps' recurrence after surgery. Dupilumab has been suggested as a treatment option for severe CRSwNP. Methods: Patients with severe CRSwNP receiving dupilumab from January 2021 were followed up at 1, 3, 6, 9 and 12 months from the first administration and were considered for this study. At baseline and at each follow-up, patients underwent nasal endoscopy and completed the Sinonasal Outcome Test (SNOT)-22, a Visual Analogue Scale (VAS) for smell/nasal obstruction, the Nasal Congestion Score and the Asthma Control Test. Peak nasal inspiratory flow (PNIF), a smell test, nasal cytology and blood eosinophilia were also evaluated. Results: Forty-seven patients were included in the study. Of these, 33 patients had a history of previous surgery (ESS) and had recurrent nasal polyps, while 14 patients were naïve to nasal surgery. Both subjective and objective parameters improved after biological treatment and were correlated with each other (p < 0.05), except for the SNOT-22 and the nasal polyp's score. No correlations were found between nasal and blood eosinophilia. No differences were observed when comparing the post-surgical and the naïve groups. Conclusions: Dupilumab improves nasal obstruction and the sense of smell and reduces the level of local inflammation in severe CRSwNP patients in a similar way in both naïve and post-surgical patients.

Correlations between Peak Nasal Inspiratory Flow, Acoustic Rhinometry, 4-Phase Rhinomanometry and Reported Nasal Symptoms.

Background: Rhinomanometry, acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) are popular methods for nasal patency evaluation. The aim of the present study was to compare these three methods with the reported nasal symptoms to determine the best diagnostic tool to assess nasal obstruction. Methods: 101 subjects were evaluated using PNIF, 4-phase rhinomanometry (4PR), AR, Visual Analogue Scale for nasal obstruction (VAS-NO) and Sino-Nasal Outcome Test (SNOT-22). Correlations among PNIF, 4PR, AR, VAS-NO and SNOT-22 were obtained. Results: VAS-NO and SNOT-22 were moderately correlated with each other (r = 0.54, p < 0.001). 4PR was moderately correlated with PNIF (r = −0.31, p = 0.0016) and AR (r = −0.5, p < 0.001). VAS-NO was mildly correlated with PNIF (r = −0.29, p = 0.0034). SNOT-22 was moderately correlated with PNIF (r = −0.31, p = 0.0017). After dividing the population into symptomatic and asymptomatic subjects, based on their VAS-NO score, the former showed significantly lower PNIF values (p = 0.009) and higher 4PR values (p = 0.013) compared to the latter ones. Conclusion: PNIF and 4PR showed a significant moderate correlation with each other, but PNIF showed a significant correlation (weak-moderate) with the reported nasal symptom scores.

First evaluation of a symbiotic food supplement in an allergen exposure chamber in birch pollen allergic patients.

BACKGROUND: Allergic rhinitis/rhinoconjunctivitis is the most common immune disease worldwide, but still largely underestimated, underdiagnosed, and undertreated. Dysbiosis and reduced microbial diversity is linked to the development of allergies, and the immunomodulatory effects of pro- and prebiotics might be used to counteract microbiome dysbiosis in allergy. Adequate symbiotic (multi-strain pro-, plus prebiotic) supplementation can be suggested as a complementary approach in the management of allergic rhinitis. OBJECTIVE: The effects of the daily intake of a symbiotic food supplement (combination of Lactobacillus acidophilus NCFM and Bifidobacterium lactis BL-04 with Fructo-Oligosaccharides) for 4 months in birch pollen allergic rhinoconjunctivitis patients were investigated for the first time in an allergen exposure chamber (AEC) allowing standardised, reproducible pollen exposure before and after intake. METHODS: Eligible patients were exposed to birch pollen (8000 pollen/m³ for 120 min) at the GA2LEN AEC, at baseline (V1) and final visit (V3) outside the season. The Total Symptom Score (TSS) and the scores for nose, eye, bronchial system, and others were evaluated every 10 min during exposure. Other secondary endpoints were the changes in well-being, Peak Nasal Inspiratory Flow (PNIF), lung function parameters, and safety. Co-primary endpoints were differences in Total Nasal Symptom Score (TNSS) and TSS after 120 min of exposure between both visits. Temporal evolution of symptom scores were analysed in an exploratory way using linear mixed effects models. RESULTS: 27 patients (mean age 45 years, 15% male) completed the study. Both co-primary endpoints showed significant improvement after intake of the symbiotic. Median TNSS and TSS were decreased 50% and 80% at 120 min (adjusted p-value = 0.025 and p < 0.01 respectively).All four symptom scores and the personal well-being, improved to a clinically relevant extent over time, visible by a weaker increase in symptoms during 120 min of the final birch pollen exposure. No relevant differences were observed for PNIF, PEF, and spirometry. There were no airway obstructions or lung restrictions before and after both exposures. Late phase reactions after exposure were reduced after V3, documenting a better birch pollen tolerability of the patients. The safety and tolerability profile of the symbiotic food supplement was excellent, no adverse events (AEs) were observed. CONCLUSIONS: This first evaluation of a symbiotic food supplement in an AEC in rhinoconjunctivitis patients with or without asthma induced by birch pollen revealed a significant beneficial effect, harnessing significant improvements of symptoms and well-being while maintaining an excellent safety and tolerability profile.

Nasal function and cardio-respiratory capacity of adolescent with external nasal dilator.

BACKGROUND: the external nasal dilator (END) has been employed for the purpose of aiding sporting performance. The objective of this study was to evaluate nasal function and cardio-respiratory capacity in healthy adolescent athletes using the END. METHODS: double-blind, crossover clinical trial in which adolescents were evaluated while using the experimental and placebo END during physical exercise. Values for peak nasal inspiratory flow (PNIF), nasal resistance (NR) and maximal oxygen uptake (VO2max) were obtained in randomized order. Additionally, the rating of perceived exertion (RPE) after the cardio-respiratory test was assessed. RESULTS: for the 71 adolescents evaluated, the use of the experimental END, compared to the placebo, produced a significant improvement in values of PNIF (177.4 ± 20.9 L/min and 172.8 ± 20.2 L/min) (p = 0.020), NR (0.24 ± 0.16 and 0.27 ± 0.16) (p = 0.007), VO2max. (39.5 ± 5.2 mL/kg. min-1 and 37.5 ± 5.2 mL/kg. min-1) (p < 0.001) and RPE (6.0 ± 2.2 and 5.5 ± 2.4) (p < 0.001), respectively. CONCLUSION: the END reduced NR, increased PNIF and improved VO2max. In addition, it improved RPE after the maximal cardio-respiratory test. The use of the END can significantly improve nasal function, increase cardio-respiratory capacity and reduce rating of perceived exertion during a maximal test involving adolescent athletes.

Upper and Lower Respiratory Signs and Symptoms in Workers Occupationally Exposed to Flour Dust.

A group of 142 bakers was studied in order to investigate the relationship between higher/lower respiratory signs/symptoms and inflammation biomarkers and occupational exposure to flour dust. A complete upper and lower respiratory tract evaluation was performed. Seven percent of bakers complained of lower respiratory symptoms, while 22% of them complained of upper respiratory symptoms. Fifty five percent of the bakers were allergic, and 37.1% showed sensitization to occupational allergens. Abnormal spirometries were found in 15% of bakers, while fractional exhaled nitric oxide (FeNO) was above the normal reference in 24.5% of them. Moreover, 23.8% of bakers were found to be hyposmic. Population mean peak nasal inspiratory flow (PNIF) was in the normal range even if almost all the workers suffered from neutrophilic rhinitis at nasal cytology with the number of nasal neutrophils increasing with the increase of the duration of exposure to flour dust (p = 0.03). PNIF and FEV1 (forced expiratory volume in the 1st second) showed a positive correlation (p = 0.03; r = 0.19). The Tiffeneau index decreased with the increase of dust (p = 0.017). A similar result was obtained once we divided our population into smokers and non-smokers (p = 0.021). Long-term exposure to bakery dusts can lead to a status of minimal nasal inflammation and allergy.

Nasal Function Changes at High Altitude.

BACKGROUND: An ever-increasing number of people are involved in sport activities at high altitude. OBJECTIVE: This study aimed to evaluate the pulmonary and nasal functions, including nasal cytology, in healthy volunteers moving for 1 week from an altitude of 2000 m to another of 3400 m. METHODS: Peak nasal inspiratory flow (PNIF), pulmonary function, including peak expiratory flow (PEF), mucociliary transport time (MCTt), nasal cytology, and oxygen saturation (O2 sat) were studied in 5 different occasions-T1: at base camp (2000 m); T2: at the mountain refuge (3400 m); T3: after 7 days at 3400 m; T4: after the return at the base camp (2000 m); and T5: at the base camp (2000 m) after 15 days. RESULTS: With respect to T1, PEF values decreased at T2 (P = .004), T3 (P = .004), T4 (P = .000), and T5 (P = .001). Forced expiratory volume in the first second and forced vital capacity did not differ among the 5 different times of measurements. In regard to T1, PNIF values increased at T2 (P = .003) and T3 (P = .001). MCTt and O2 sat showed similar but opposite changes with MCTt increased at T2 and T3 in respect to T1 (P = .000 for both), while O2 sat decreased at T2 and T3 in respect to T1 (P = .000 for both). At nasal cytology, the number of neutrophils increased at T2 in respect to T1 (P = .008). At multivariate analysis, PNIF changed with altitude from T1 to T4 even accounting for the effect of all the other variables (T1 vs T2 PNIF, P = .009; T1 vs T3 PNIF, P = .007; T1 vs T4 PNIF, P = .021). CONCLUSIONS: Although the study has some limitations, being conducted on a small cohort and at no controlled environmental conditions, data seem to support the utility of MCTt for studying nasal mucosa damage induced by high altitude. Nasal cytology seems to be able to identify the inflammation of the nasal mucosa exposed to hypoxia. Further investigations on larger series and possibly conducted in hypobaric chamber at controlled standardized conditions are necessary in order to confirm these results and, most importantly, the improvement of PNIF at high altitude.

Nasal IgE in subjects with allergic and non-allergic rhinitis.

PURPOSE: The prevalence of "ocal allergic rhinitis" within individuals suffering from perennial rhinitis remains uncertain, and patients usually are diagnosed with non-allergic rhinitis. The aim of this study was to evaluate the prevalence of a potential "local allergic rhinitis" in subjects suffering from non-allergic rhinitis in a non-selected group of young students. METHODS: 131 students (age 25.0 ± 5.1 years) with a possible allergic rhinitis and 25 non-allergic controls without rhinitis symptoms (age 22.0 ± 2.0 years) were recruited by public postings. 97 of 131 students with rhinitis were tested positive (≥3 mm) to prick testing with 17 frequent allergens at visit 1. Twenty-four 24 subjects with a house dust mite allergy, 21 subjects with a non-allergic rhinitis, and 18 non-allergic controls were further investigated at visit 2. Blood samples were taken, and nasal secretion was examined. In addition, all groups performed a nasal provocation test with house dust mite (HDM). RESULTS: In serum and nasal secretion, total IgE and house dust mite specific IgE significantly differed between HDM positive subjects and controls. However, no differences between non-allergic subjects and control subjects were quantifiable. Neither a nasal provocation test nor a nasal IgE to HDM allergens showed a measurable positive response in any of the non-allergic rhinitis subjects as well as the healthy controls, whilst being positive in 13 subjects with HDM allergy. CONCLUSIONS: Nasal IgE is present in subjects with HDM allergy, but not in non-allergic rhinitis. In the investigated non-selected population, exclusive local production of IgE is absent. By implication, therefore, our findings challenge the emerging concept of local allergic rhinitis.Study identifier at ClinicalTrials.gov: NCT02810535.

Medical devices in allergy practice.

Medical devices provide people with some health benefits in terms of diagnosis, prevention, treatment, and monitoring of disease processes. Different medical specialties use varieties of medical devices more or less specific for them. Allergology is an interdisciplinary field of medical science and teaches that allergic reactions are of systemic nature but can express themselves at the level of different organs across the life cycle of an individual. Subsequently, medical devices used in allergology could be regarded as: 1) general, servicing the integral diagnostic and management principles and features of allergology, and 2) organ specific, which are shared by organ specific disciplines like pulmonology, otorhinolaryngology, dermatology, and others. The present position paper of the World Allergy Organization (WAO) is meant to be the first integral document providing structured information on medical devices in allergology used in daily routine but also needed for sophisticated diagnostic purposes and modern disease management. It is supposed to contribute to the transformation of the health care system into integrated care pathways for interrelated comorbidities.

Mometasone furoate is not superior to saline for chronic rhinitis in the elderly.

INTRODUCTION: Prevalence of diseases associated with ageing is rising; among these are the rhinologic problems. Chronic rhinitis appears as one of the most common worrisome nasal disorders in this age group. At the same time, the allergic form diminishes because of the immunosenescence. OBJECTIVE: This study aimed to evaluate the effect of a corticosteroid nasal spray (mometasone furoate) over nasal patency and the severity of rhinitis and its impacts on quality of life as compared with the saline nasal spray. METHODS: This open label-trial randomized subjects ≥60y with chronic rhinitis (allergic and nonallergic rhinitis) with mometasone spray 100mcg/d and isotonic saline nasal spray or saline alone for two weeks. The primary endpoint was the improvement in nasal patency evaluated by the peak nasal inspiratory flow (PNIF). Secondary outcomes included the severity of symptoms and the quality of life assessed by a visual analogic scale (VAS) and the sinonasal outcome test (SNOT-22), respectively. RESULTS: Forty patients underwent randomization, in equal number in each group of treatment, either with allergic (AR) and nonallergic rhinitis (NAR). At week 2, the mean PNIF score was 79.5 in the corticosteroid (CE) plus saline group and 82.0 in the saline group (p = 0.37). Also, SNOT-22 and VAS were not improved with the addition of mometasone furoate. CONCLUSIONS: Treatment with mometasone furoate nasal spray plus isotonic saline is not superior to saline alone in elderly patients with rhinitis in respect of improving nasal patency, quality of life, and reducing the intensity of symptoms. TRIAL REGISTRATION: The trial is registered at the Brazilian Clinical Trials Registry (ReBEC) #RBR-498bnq. Registered 05 July 2017.

Effect of the external nasal dilator on adolescent athleteswith and without allergic rhinitis.

OBJECTIVES: The ability to effectively breathe through the nose is an important component of physical exercise. The goal of this study is to evaluate the effect of the external nasal dilator (END) on healthy adolescent athletes and those with allergic rhinitis. METHODS: Clinical trial, double-blind, crossover, in which we evaluated healthy adolescent athletes with allergic rhinitis, using experimental and placebo ENDs, submitted to a maximum cardio-respiratory test in randomized order. Predicted values for peak nasal inspiratory flow (PNIF%) and nasal resistance (NR) were obtained, and the rating of perceived exertion (RPE) was also assessed after the race test. RESULTS: 65 adolescents participated in the study, 30 of whom had allergic rhinitis. The use of experimental ENDs demonstrated a statistically significant improvement in peak nasal inspiratory flow values (predicted %), nasal resistance, maximal oxygen uptake value (VO2Max.) and rating of perceived exertion, both in the healthy group and the one with allergic rhinitis. CONCLUSION: Results suggested that END reduces nasal resistance, improves maximal oxygen uptake and rating of perceived exertion after a maximum cardio-respiratory test on healthy adolescents and those with allergic rhinitis.

Breathing parameters associated to two different external nasal dilator strips in endurance athletes.

OBJECTIVE: The aim of the study was to investigate and compare the effects of two different external nasal dilator strips (ENDS) on nasal respiratory flow, maximal oxygen uptake (VO2max), nasal VO2max, time to exhaustion and subjective nasal obstruction in adult triathletes participating in exhaustive, controlled physical exercise tests. METHODS: Thirteen healthy triathletes without nasal symptoms were recruited and randomly tested in three different conditions: without ENDS, wearing the Breathe Right® dilator strip and wearing the Master-aid Roll-flex® strip. We investigated the variations in the peak nasal inspiratory flow (PNIF) and the Nasal Obstruction Symptom Evaluation questionnaire before and after an exhaustive treadmill test. VO2max, nasal VO2max, time to exhaustion, total time of nasal respiration values were also registered and compared. RESULTS: Post-exercise PNIF was higher than the pre-exercise PNIF. Pre-exercise PNIF was higher in athletes wearing the Master-aid Roll-Flex® than in those wearing the Breathe Right® strips; no differences in post-exercise PNIF values were found in the three different conditions. Nasal VO2max value was higher when both types of ENDS were worn. Nasal respiration time to exhaustion was longer when the athletes were wearing either type of ENDS. Both ENDS gave a better sensation of nasal airflow passage after physical exercise. CONCLUSION: ENDS had similar effects, improving the subjective sensation of nasal patency, the nasal respiration time, and the nasal VO2max, anyway Master-aid Roll-flex® is more economic than the Breathe Right® and it can be cut to fit the nasal anatomy. As ENDS affect the cross-sectional area, especially at the level of the nasal valve, in future studies should be conducted also by means of acoustic rhinometry in order to evaluate if any difference could be find at this level when wearing either one of the two ENDS.

Comparison of the Efficacy of Septoplasty with Nonsurgical Management in Improving Nasal Obstruction in Patients with Deviated Nasal Septum - A Randomized Clinical Trial

Abstract Introduction In the current era, the major indication for septoplasty is nasal obstruction due to deviated nasal septum (DNS). Even though septoplasty is a commonly performed surgery, its effectiveness in relieving nasal obstruction in DNS has not been proven. Objective The present study involved the measurement of both objective (nasal patency) and subjective (quality of life measures) outcome measures for the evaluation of the efficacy of septoplasty as compared with medical management. Methods Patients with DNS presenting with nasal obstruction were included and randomized into a septoplasty group or into a nonsurgical management group, with 70 patients in each group. The improvement in nasal obstruction was assessed subjectively by the visual analogue scale (VAS), and the sino-nasal outcome test-22 (SNOT-22) and the nasal obstruction symptom evaluation (NOSE) questionnaires and was measured objectively by assessment of nasal patency by peak nasal inspiratory flow (PNIF) at 0, 1, 3, and 6 months of treatment in both groups. Results The average VAS, SNOT-22 and NOSE scores for the septoplasty versus the nonsurgical group before treatment were 6.28 versus 6.0, 19.5 versus 15, and 14 versus 12, respectively, and at 6 months post-treatment, the scores were 2.9 versus 5.26, 10 versus 12, and 8 versus 10 (p= 0.001), respectively. The average PNIF scores at 0 and 6 months were 60/50 l/min and 70/60 l/min, respectively, in the septoplasty group (p= 0.001); the scores at 0 and 6 months in the nonsurgical management group were 60/60 l/min and 70/70 l/min, respectively (p= 0.001). Conclusion Surgical correction of DNS by septoplasty improves nasal obstruction better than nonsurgical management at 6 months postsurgery.