Gold standard diagnostic algorithm for the differential diagnosis of local allergic rhinitis.

Local allergic rhinitis, defined as a localized allergic response of the nasal mucosa in the absence of systemic atopy, poses a considerable clinical issue due to its prevalence. The gold standard in local allergic rhinitis diagnostics is primarily the patient's history taking and nasal allergen provocation testing or, alternatively, the basophil activation test, described as "an allergic reaction in a test tube".

Objectification of the nasal patency assessment techniques used in nasal allergen provocation testing.

Topical allergen application in nasal provocation testing (NPT) is associated with remarkably rapid changes in nasal patency. Thus, selecting the techniques of assessing the extent of nasal obstruction (as one of the responses to topical allergen application) is an important component of NPT. The study attempted to systematize and evaluate the techniques selected for assessing nasal patency during NPT based on a review of relevant literature. We reviewed the literature on the attempts to standardize the objective techniques for assessing nasal patency and their use in NPT. The best known, well-established technique for assessing nasal patency as part of NPT was rhinomanometry, followed by peak nasal inspiratory flow (PNIF) testing and acoustic rhinometry.

The role of the nasal allergen provocation test in local allergic rhinitis cases: a preliminary report.

INTRODUCTION: The current state of knowledge is that allergic rhinitis can occur in two forms. One is allergic rhinitis as a manifestation of a systemic allergy with systemic atopy and positive results of skin prick tests or sIgE tests. The other is local allergic rhinitis (LAR) as a local allergic reaction affecting only the nasal mucosa without systemic atopy. AIM: To attempt to assess the usefulness of the nasal allergen provocation test for the purposes of differential diagnosis and the qualification of LAR patients for therapy. MATERIAL AND METHODS: The subjects in the study were a group of 6 adults diagnosed with LAR on the basis of their medical history and the results of nasal allergen provocation tests, with the allergens being house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae). The methods adopted in the study were a point-based rating scale as a measure of nasal/extranasal complaints and active anterior rhinomanometry. RESULTS: Significant differences (p < 0.05) were observed, using the subjective rating scale, in relation to registered nasal and extranasal complaints in the early phase of the allergic reaction. Similarly, the rhinomanometry method revealed significant differences in nasal resistance values before and after the administration of an allergen. CONCLUSIONS: The nasal allergen provocation test is the only testing tool that objectively measures the degree of the patient's allergic reactions and is useful in qualifying LAR patients for further therapy.

Building age, type of indoor heating and the occurrence of allergic rhinitis and asthma.

INTRODUCTION: Structural materials and interior appliances are frequently mentioned as elements of modern buildings which may have an impact on the natural history of allergic diseases. AIM: We hypothesized that the building age, the type of the heating system and the use of various indoor appliances can influence the occurrence of allergic rhinitis (AR) and asthma. MATERIAL AND METHODS: The study group comprised 18,617 individuals. The tool used in the study was the European Community Respiratory Health Survey (ECRHS) and the International Study of Asthma and Allergies in Childhood (ISAAC) study questionnaire, adapted to European conditions (Middle and Eastern Europe) and used as part of the study called "Implementation of a System for the Prevention and Early Detection of Allergic Diseases in Poland". RESULTS: Questionnaire results indicated that people living in homes built in the years 1971-1990 had higher rates of allergic rhinitis (OR = 1.15025), which was correlated with clinical findings of increased occurrence of seasonal allergic rhinitis (OR = 1.60543). The leading factor contributing to the intensification of AR symptoms was the central heating (OR = 1.45358). As opposed to AR, people living in buildings with central heating less often declared asthma (OR = 0.8407). A clinical examination confirmed that central heating reduced the symptoms of moderate asthma (OR = 0.3524). CONCLUSIONS: Increasing building age and certain indoor heating methods are important risk factors for the occurrence of allergic rhinitis and asthma.

Effect of indoor air quality on the natural history of asthma in an urban population in Poland.

Background: Indoor air pollution may have an impact on asthma. Objective: To evaluate the influence of indoor air pollution on the natural history of asthma. Methods: Data collection by using the European Community Respiratory Health Survey and International Study of Asthma and Allergies in Childhood standardized questionnaire (N = 18,617) and medical examinations (N = 4783) in selected Polish regions was used. Statistical analysis was performed by using the χ² test. A value of p < 0.05 was considered statistically significant. Results: Questionnaire results demonstrated that people who used the central heating system were less likely to declare the occurrence of asthma (odds ratio [OR] 0.84) and were corroborated with clinical findings of moderate asthma (OR 0.35). Symptomatic asthma occurred more frequently in people who used a solid-fuel heating device (OR 1.36) and electric heaters (OR 1.54). The use of cooking appliances with municipal natural gas (OR 1.77) and gas storage tanks (OR 2.03) was correlated with more frequent declarations of asthma. Symptomatic asthma was more common among people who smoked for at least 1 year (OR 2.26) and those who smoked over the course of the preceding month (OR 1.60). Passive exposure to tobacco smoke provided for a 1.5-fold increase in the incidence of symptomatic asthma (OR 1.53), regardless of the time of exposure. Conclusion: Both active and passive tobacco smoke exposure as well as the use of certain types of heating and cooking appliances have a significant impact on the incidence of asthma and the intensification of its symptoms in rooms with limited air exchange. Highlights of the study included the following: (1) central heating had an amelioratory effect on asthma, (2) heating technologies used at home had a significant impact on the incidence of asthma, and (3) devices used for cooking (municipal and cylinder gas stoves) played an important role in the intensification of asthma symptoms.

The importance of specific IgE antibodies in epidemiology of allergic rhinitis and asthma - the Epidemiology of Allergic Diseases in Poland (ECAP) survey: part one. Influence of allergy risk factors on concentration of specific IgE antibodies in serum.

INTRODUCTION: Specific immunoglobulins E (sIgE) are important parameters to estimate severity of allergic diseases. AIM: To determine the influence of allergy risk factors on the concentration of specific IgE antibodies in serum. MATERIAL AND METHODS: The concentration of sIgE antibodies against allergens Dermatophagoides pteronyssinus, cat dander, timothy grass, Alternaria alternata were determined in serum of 4077 respondents randomly selected from 9 regions (ECAP study). The positive results of sIgE (≥ 0.35 IU/ml) were correlated to answers in questionnaires ECRHSII and ISAAC. RESULTS: sIgE are more frequently detected in respondents declaring an allergic disease of a father than of a mother (D. pteronyssinus p < 0.05, A. alternata p < 0.01). An early beginning to attend school, kindergarten or nursery increases the frequency of sIgE detection (p < 0.05). If the number of children who slept in the same room as a respondent before the respondent was five years old, was lower, sIgE antibodies are more frequently detected (p < 0.05). Relating to: 1) all 4 allergens, sIgE are the most frequently detected in respondents declaring absence of a carpet/rug at home (p < 0.05), 2) cat dander - less frequently detected in respondents who have a cat at home at the age of 1-4 years (p < 0.005). CONCLUSIONS: Carpets/rugs capture a portion of mite, epidermal, mould allergens located at home, wherefore absence of a carpet or rug causes greater stimulation of an immune system by these allergens; as a consequence, IgE antibodies are the most frequently detected in respondents. Household contacts of the respondents, at the age of 1-4 years, with cats induced partial immune tolerance to cat dander.

Diagnostic significance of nitric oxide concentrations in exhaled air from the airways in allergic rhinitis patients.

INTRODUCTION: The effect of nitric oxide (NO) on the human body is very important due its physiological regulation of the following functions of airways: modulation of ciliary movement and maintenance of sterility in sinuses. AIM: To evaluate the diagnostic significance of NO concentrations in exhaled air from the upper and lower airways in patients diagnosed with allergic rhinitis (AR). MATERIAL AND METHODS: The subjects included in the study were a group of 30 people diagnosed with sensitivity to environmental allergens and a control group consisting of 30 healthy subjects. The measurement of NO in the air exhaled from the lower and upper airways was performed using an on-line method by means of Restricted Exhaled Breath (REB), as well as using the measurement procedure (chemiluminescence) set out in the guidelines prepared in 2005 by the American Thoracic Society and the European Respiratory Society. RESULTS: In the late phase of the allergic reaction, higher values of the level of exhaled NO concentration from the lower airways were observed in the groups of subjects up to the threshold values of 25.17 ppb in the group of subjects with year-round allergic rhinitis and 21.78 ppb in the group with diagnosed seasonal allergic rhinitis. The difference in the concentration of NO exhaled from the lungs between the test group and the control group in the 4(th) h of the test was statistically significant (p = 0.045). CONCLUSIONS: Exhaled NO should be considered as a marker of airway inflammation. It plays an important role in the differential diagnosis of allergy.

Allergies in urban versus countryside settings in Poland as part of the Epidemiology of the Allergic Diseases in Poland (ECAP) study - challenge the early differential diagnosis.

INTRODUCTION: The incidence of allergies depends on a number of factors, including adopting an urban "western" lifestyle, genetic predispositions, and different regions of residence. AIM: To compare the prevalence of allergic conditions (seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR), bronchial asthma (BA), atopic dermatitis (AD)) in a group of countryside versus urban residents in Poland. MATERIAL AND METHODS: The prevalence of allergic conditions in urban versus countryside settings was assessed using the translated and approved questionnaire developed for international ECRHS II and ISAAC studies. Respondents were selected via random multistage sampling, with proportionate stratified sampling, and the Polish Resident Identification Number (PESEL) as the basis. A total of 18,617 respondents took part in the study. Subsequently, approximately 25% of the subjects underwent outpatient assessments: skin-prick, lung function, peak nasal inspiratory flow (PNIF) tests, as well as history-taking. RESULTS: Allergic rhinitis (AR) proved to be the most common condition in the entire study population. Children residing in the countryside were twice more likely to be diagnosed with BA (8.33% vs. 4%; p < 0.05). Conversely, in the adult subgroup, BA was more commonly observed in urban areas. Whereas reported symptom rates were much higher in AR and AD patients, symptomatic BA was proportionately lower with respect to the official diagnoses (underdiagnosed BA phenomenon). Atopic dermatitis was considerably more common in the metropolitan population. One factor that significantly correlated with allergic diseases was a positive family history. CONCLUSIONS: Inhabitants of metropolitan areas are to a greater extent predisposed to allergic conditions. One factor significantly contributing to allergies is genetic predisposition. Given the scale of the problem, there is an urgent need to implement measures for early prevention and diagnosis of allergies to minimize distant health effects.

Changes in nasal cavity dimensions in children and adults by gender and age.

OBJECTIVE: The aim of the study was to establish the dynamics of changes in the intranasal spaces of children and adults by gender and age. MATERIALS AND METHODS: Each side of the nasal cavity was evaluated separately in 366 healthy subjects 9 to 74 years old. The following acoustic rhinometry parameters were analyzed: 1) I-C, distance between the isthmus nasi (I) and the head of the inferior turbinate (C); 2) CA-I, cross-sectional area at the isthmus nasi; 3) CA-C, at the head of the inferior turbinate; and 4) CA-F, the highest point on the rhinometric curve between points I and C. RESULTS: Before age 11 years, the intranasal spaces were slightly larger in girls than in boys. After age 11 years the nasal parameters were larger in boys than in girls. The growth rates before age 17 years were as follows: I-C: 0.073 cm/yr, 0.135 cm/yr, CA-F: 0.055 cm2/yr, 0.133 cm2/yr (P < .00001), and CA-C: 0.010 cm2/yr, 0.034 cm2/yr (P < .02) in girls and boys, respectively. In subjects older than 16 years, the mean values of I-C were 1.707 cm, 1.934 cm (P < .0001), and of CA-C, 0.493 cm2, 0.611 cm2 (P < .0001) in women and men, respectively, and changed slightly over the year. CONCLUSIONS: The parameters of intranasal spaces depend on age and gender. The dynamics of the changes is greater in boys than in girls and usually the growth is completed by the age of 16. After this age, nasal cavities are bigger in men than in women.

[Nasal polyps is not a homogenous pathology]. / Polipy nosa--niejednorodna patologia.

UNLABELLED: Nasal polyposis is still a disease of unknown etiology. Looking at its clinical course it seems to be not homogenous pathology. Inflammation of the mucosa, mainly eosinophilic is probably the most important factor, which leads to the development of nasal polyps. THE AIM OF STUDY: To analyze and compare the history data and eosinophilic inflammation parameters in patients with nasal polyps. MATERIAL AND METHODS: 67 patients with nasal polyposis were included into the study. They were divided into three groups: PP-primary nasal polyps (n = 33-49.2%); A-polyps and bronchial asthma without aspirin intolerance (n = 19-28.4%); ASA-polyps and aspirin-induced asthma (n = 15-22.4%). The history data were taken using patient's questionnaire. To assess the eosinophilic inflammation intensity the blood and nasal eosinophilia and serum eosinophilic cationic protein (ECP) concentration were measured. RESULTS: The average age of all patients was 55 +/- 1.5 (range 32-76), the age distribution was comparable in all groups. The ratio males:females--1.5:1 (PP--2.7:1; A--1.1:1; ASA--0.7:1. The females with nasal polyps much more often suffer from asthma than males (p = 0.036). The age when polyps were first seen was 45.1. The duration of nasal polyps was 10 +/- 10 years (range 0.5-30 years): PP-- 10 +/- 9; A-- 14 +/- 11; ASA-- 7 +/- 7 (A/ASA-- p = 0.045). Period of 6.6 years of rhinitis had preceded the diagnosis of nasal polyposis (PP--7.3; A--7.1; ASA--4.5). Age when asthma was developed (A+ASA groups)--45.5; the duration of asthma was 11 +/- 9 years. 58% of patients had polypectomy/ethmoidectomy (PP--45%; A--60%; ASA--80%). The number of operations per one patient: 1.3 (PP--1.0; A--1.2; ASA--2.0), the most often performed in ASA group (PP/ASA-- p = 0.01 and A/ASA-- p =0.045). The mean interval between polypectomies in all patients--9.1 years (PP--10; A--12, ASA--3.5). Blood eosinophilia: 5.6 +/- 0.4% (PP-- 4.6 +/- 0.5; A-- 6.2 +/- 0.9; ASA-- 7.2 +/- 0.9% and PP/ASA-- p = 0.019; PP/A+ASA-- p = 0.03). Nasal eosinophilia: 18.5 +/- 3% (PP-- 15.0 +/- 4; A-- 15.5 +/- 6; ASA-- 30.0 +/- 8% and PP/ASA-- p = 0.01; A/ASA-- p = 0.02). Serum ECP concentration: 24 +/- 2 microg/l. CONCLUSIONS: The patient's history and the intensity of eosinophilic inflammation are not similar in all nasal polyposis patients, that support the classification into PP, A and ASA groups. The most severe clinical picture and the highest values of eosinophilic parameters are observed in ASA group. Aspirin intolerance seems to be unfavourable prognostic factor in nasal polyposis.

Consequences of smoke inhalation in the 'Epidemiology of Allergic Diseases in Poland' project (ECAP).

This paper presents a risk assessment of individuals with respiratory allergies who are exposed to active and passive tobacco smoke (environmental tobacco smoke or ETS). Smoking tobacco and ETS is a serious environmental hazard known to be harmful to human health. This analysis is based on the results of the Epidemiology of Allergic Diseases in Poland (ECAP) study, which was conducted from 2006-2008 on a sample of approximately 22,500 respondents in 9 areas of Poland, both urban and rural. Data collection was based on individual interviews and a questionnaire employing Computer Assisted Personal Interviewing technology (CAPI). 46.8% of respondents declared themselves as smokers, defined as those who smoke and have done so for at least one year. In this group, 41.5% of respondents were female and 54.3% were male. While differences between various areas of Poland were demonstrated, they did not necessarily correlate with urbanization. Rural Zamosc reported 41.4% of smokers while metropolitan Poznan had 41.9% of smokers. These statistics can be contrasted against other urban areas such as Katowice and Gdansk, which had 51.8% and 52.3% of smokers, respectively (n = 9376). 29.6% of rural women reported smoking, while this percentage was higher among urban women, ranging from 36.3% in Poznan to 49.5% in Gdansk. However, the highest percentage of smokers was among males in Zamosc at 56.1%. This percentage was higher than the overall average in this study. The largest percentages of active smoking occurred among laborers, craftsmen, miners, drivers, farmers and fishermen, the self-employed and gardeners. This quantitative assessment of the prevalence of smoking underlines the importance of the consequences of this habit as they relate to asthma and respiratory allergies. The findings demonstrate smoking as a serious social problem associated with allergic diseases, and a habit that differs between place of residence and work environment.