RESUMEN
INTRODUCTION: Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disease characterized by recurrent epistaxis, mucocutaneous telangiectasia and visceral arteriovenous malformations. The nosebleeds can be life-threatening and in these circumstances, radical treatment is required. METHODS: Since 1994, closure of the nose has been undertaken to prevent severe nasal bleeding in patients meeting specific selection criteria. Outcome data collected on this cohort pre- and post-operatively is available for analysis. RESULTS: From a cohort of 515 HHT patients, 100 have undergone nasal closure, bilateral ab initio in 81%. Fifty patients completed pre- and post-operative epistaxis severity questionnaires and provided information on post-operative problems and 28 completed a Glasgow Benefit Inventory (GBI). Overall most patients derived significant benefit from the procedure with complete cessation of nasal bleeding in 94%, a highly significant improvement in the epistaxis score and a mean GBI score of 53.4. Loss of smell and taste was the most frequent post-operative complaint. CONCLUSION: HHT can be associated with life-threatening epistaxis significantly affecting patients quality of life. Permanent prevention of airflow is associated with complete or near-total cessation of epistaxis in the majority of patients.
Asunto(s)
Epistaxis/cirugía , Cavidad Nasal/cirugía , Telangiectasia Hemorrágica Hereditaria/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND: Aspirin-exacerbated respiratory disease is under-diagnosed and therefore effective and inexpensive therapy with aspirin desensitization is rarely performed. METHODS: We present an audit of 150 patients with difficult to treat nasal polyposis, 132 of whom also had asthma, 131 of whom underwent challenge with the only soluble form of aspirin, lysine aspirin (LAS), to confirm or exclude the diagnosis of aspirin-exacerbated respiratory disease (AERD). RESULTS: One hundred patients proved positive on nasal challenge, 31 who were negative went onto oral LAS challenge and a further 14 gave positive results, leaving 17 who were negative to a dose equivalent to over 375 mg of aspirin. Nineteen were not challenged because of contraindications. With the exception of one patient who developed facial angioedema and two patients with > 20% drop in FEV1 (following nasal plus oral challenge) no other severe adverse events occurred. No hospitalization was required for these three patients. Nasal inspiratory peak flow monitoring was less sensitive to obstruction caused by aspirin than was acoustic rhinometry - which should be employed when aspirin challenge is an outpatient procedure. CONCLUSIONS: Provided patients are carefully chosen and monitored LAS challenge is suitable for ENT day case practice where respiratory physician help with asthma is available and should reduce the under-diagnosis of this condition.
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Aspirina/análogos & derivados , Aspirina/efectos adversos , Asma Inducida por Aspirina/diagnóstico , Lisina/análogos & derivados , Rinitis/inducido químicamente , Rinitis/diagnóstico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Provocación Nasal , Reproducibilidad de los ResultadosRESUMEN
INTRODUCTION: Nasal polyposis associated with aspirin-intolerant asthma tends to be difficult to control, with frequent recurrences. We examined the effect of intranasal lysine-aspirin administration on resistant nasal polyps of asthmatic, aspirin-intolerant patients, when used in addition to routine therapy. PATIENTS AND METHODS: Thirteen patients with asthma and intolerance to aspirin were recruited. All but one had undergone numerous polypectomies and were uncontrolled on standard therapy with intranasal corticosteroids, leukotriene receptor antagonists and nasal douching. Aspirin treatment involved one drop (100 microl) of 30 mg/ml lysine-aspirin solution to each nostril, initially daily, increased every two or three days up to a maximal of 18 drops (54 mg lysine-aspirin) a day. Nasal symptoms, nitric oxide level, nasal inspiratory peak flow rate, peak expiratory flow rate and nasendoscopic grading were assessed prior to therapy and three months later. We also compared the change in endoscopic polyp scores during three months of lysine-aspirin administration with the changes which had occurred during the three months prior to administration (during which time other therapies had been identical). RESULTS: Nasal blockage symptoms tended to decrease; other nasal symptoms were unchanged. Significant changes were seen in nasal inspiratory peak flow rate (103.3 +/- 18.9 and 140.0 +/- 16.7 l/min before and after aspirin, respectively; p = 0.014), but not in peak expiratory flow rate (438.7 +/- 33.4 and 440.0 +/- 28.4 l/min before and after aspirin, respectively; p = 0.700). Nasal nitric oxide levels rose significantly (in both sides, p = 0.028). Expired chest nitric oxide levels did not change. Nasal polyp scores on nasendoscopic examination were significantly reduced (right side, p = 0.027; left side, p = 0.018). Compared with the preceding three months, adding intranasal lysine-aspirin application had the effect on decreasing nasal polyp volume (right side, p = 0.031; left side, p = 0.016). CONCLUSION: This open study suggests that intranasal lysine-aspirin administration reduces nasal polyp volume in aspirin-intolerant patients, without any adverse affect on concomitant asthma. This was a preliminary study and should be followed by a placebo-controlled, double-blind trial.
Asunto(s)
Antiinflamatorios no Esteroideos/administración & dosificación , Aspirina/análogos & derivados , Asma/complicaciones , Lisina/análogos & derivados , Pólipos Nasales/tratamiento farmacológico , Administración Intranasal , Adulto , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/administración & dosificación , Aspirina/efectos adversos , Aspirina/uso terapéutico , Asma/inducido químicamente , Endoscopía , Femenino , Humanos , Lisina/administración & dosificación , Lisina/efectos adversos , Lisina/uso terapéutico , Masculino , Persona de Mediana Edad , Pólipos Nasales/etiología , Pólipos Nasales/metabolismo , Pólipos Nasales/patología , Óxido Nítrico/metabolismo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVES: A high prevalence of chronic hyperventilation syndrome in patients with asthma has been reported. We examined whether this phenomenon extended to allergy clinic patients in general and whether the prevalence was higher in patients attending a general allergy clinic compared with those attending a routine ENT clinic in our hospital. METHODS: We examined the prevalence of hyperventilation syndrome in unselected, consecutive patients (n = 100) seen in an allergy clinic. The validated Nijmegen questionnaire was completed by patients in the waiting room. We also administered the questionnaire to unselected, consecutive patients (n = 100) in a routine ENT clinic. RESULTS: There was no significant difference in prevalence of hyperventilation between allergy clinic and routine ENT clinic patients (25/100 vs 23/100). CONCLUSION: The result indicates a high prevalence of hyperventilation amongst hospital attendees in general. Consideration should perhaps be given to the possible role of hyperventilation in symptomatology.
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Hipersensibilidad/epidemiología , Hiperventilación/epidemiología , Enfermedades Otorrinolaringológicas/epidemiología , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Londres , Masculino , Persona de Mediana Edad , Servicio Ambulatorio en Hospital , Prevalencia , Autorrevelación , Encuestas y CuestionariosRESUMEN
BACKGROUND: Nasal polyposis occurs frequently in patients with intrinsic asthma, especially in those who are aspirin sensitive. It can be difficult to treat effectively, even with surgery and regular topical intranasal corticosteroids many patients are still symptomatic. OBJECTIVE: To investigate the response to montelukast, a leukotriene D4 receptor antagonist, as an add-on therapy to topical and inhaled corticosteroids in patients, both aspirin sensitive (AS) and aspirin tolerant (AT), with nasal polyposis and asthma. METHODS: Nasal polyposis symptoms were assessed by visual analogue scales; nasal polyps were assessed by nasendoscopy and via the measurement of nasal volumes by acoustic rhinometry. The nasal airway was assessed by nasal inspiratory peakflow (NIPF). Asthma was monitored using symptom scores and peak expiratory flow measurements. Aspirin sensitivity was assessed by history together with intranasal lysine aspirin challenge. Upper and lower airway nitric oxide measurements were made before and during treatment. RESULTS: Clinical subjective improvement in nasal polyposis occurred in 64% AT (P < 0.01), patients and 50% AS patients (P > 0.05); asthma improvement in 87% AT and 61% AS patients (P < 0.05 for both). Objective changes in peak flow occurred only in AT patients (P < 0.05). Acoustic rhinometry, nasal inspiratory peak flow and nitric oxide levels did not change significantly in any group, however, correlations were seen between nitric oxide levels and polyp scores and between nitric oxide levels and acoustic rhinometry changes. Improvement on montelukast therapy was not associated with any of the following variables: age, sex, skin prick test positivity, disease duration or aspirin sensitivity. (P > 0.05 for all). CONCLUSION: The findings are consistent with a subgroup of nasal polyps/asthma patients in whom leukotriene receptor antagonists are effective. This is not related to aspirin sensitivity. Further placebo-controlled studies need to be undertaken.
Asunto(s)
Acetatos/uso terapéutico , Antiasmáticos/uso terapéutico , Asma/complicaciones , Asma/tratamiento farmacológico , Antagonistas de Leucotrieno/uso terapéutico , Pólipos Nasales/complicaciones , Pólipos Nasales/tratamiento farmacológico , Quinolinas/uso terapéutico , Adulto , Anciano , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/efectos adversos , Aspirina/uso terapéutico , Asma/inducido químicamente , Tiempo de Sangría , Ciclopropanos , Femenino , Humanos , Capacidad Inspiratoria/efectos de los fármacos , Capacidad Inspiratoria/fisiología , Masculino , Persona de Mediana Edad , Óxido Nítrico/metabolismo , Ápice del Flujo Espiratorio/efectos de los fármacos , Ápice del Flujo Espiratorio/fisiología , Sensibilidad y Especificidad , Pruebas Cutáneas , SulfurosRESUMEN
Chronic rhinosinusitis (CRS) is a recalcitrant inflammatory process which has a marked detrimental impact on quality of life. At the present there is no cure for this condition, measures are taken to stop progression, and provide symptomatic relief. Topical corticosteroids are commonly prescribed in the management of CRS, but few trials show effectiveness in clinical settings. We set up a randomized, double-blind, placebo-controlled trial to study the effectiveness of a topical corticosteroid agent--fluticasone propionate aqueous nasal spray (FPANS) in patients with CRS. We measured symptoms, diary card, and rigid endoscopy scores, acoustic rhinometry, middle meatal swabs, blood tests--CRP, ESR, WBC, and eosinophil count. Measurements were done at the start of the trial, at 8 weeks, and 16 weeks where possible. Twenty-two patients completed the trial, 9 received FPANS, and 13 had placebo. There was no difference between the 2 groups on all counts. When patients were considered as one group, there was an improvement in the diary card scores (p = 0.054), comparing baseline to 8 or 16 weeks. There was no evidence that the regular use of topical corticosteroid increased the risk of developing an infection. An important observation was that the topical corticosteroid did not precipitate acute sinusitis. There is compelling evidence that topical corticosteroids down-regulate cytokine expression, and it is likely that a larger, and longer multi-centre trial may prove their efficacy in CRS.
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Androstadienos/administración & dosificación , Antiinflamatorios/administración & dosificación , Rinitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Administración Intranasal , Adulto , Enfermedad Crónica , Método Doble Ciego , Femenino , Fluticasona , Glucocorticoides , Humanos , Masculino , Placebos , Estadísticas no ParamétricasRESUMEN
We studied 209 children, referred to a multi-disciplinary 'Glue ear/Allergy' clinic at our hospital with a history of chronic or recurrent otitis media with effusion (OME), in order to determine the prevalence of atopic disease in this population. Referrals were made either from within the hospital by Ear, Nose and Throat (ENT) Surgeons and Audiological Physicians (internal), or by General Practitioners (external). Assessment of atopic status was based on medical history, physical examination, nasal smears and skin-prick testing (SPT) in all children; and on blood eosinophil counts and total immunoglobulin E (IgE) levels in a randomly selected subset. The main outcome measures were number of children with rhinitis, asthma, eczema, positive SPT, raised IgE level (> 100 IU/l), and nasal and blood eosinophilia. We found allergic rhinitis in 89%, asthma in 36%, and eczema in 24%. SPTs were positive to one or more of eight common inhalant aeroallergens in 57% of children. Blood tests in the selected subset revealed eosinophilia in 40% and a raised serum IgE in 28%. The worldwide prevalence of allergic rhinitis in children has been estimated to be 20%. The 89% prevalence found in this study is very high and there are a number of reasons which suggest that there may be a causal relationship. Whole-population studies will be required to confirm these findings, which could have important therapeutic implications for OME.
Asunto(s)
Hipersensibilidad Inmediata/complicaciones , Otitis Media con Derrame/complicaciones , Alérgenos/inmunología , Asma/epidemiología , Asma/inmunología , Niño , Preescolar , Enfermedad Crónica , Eccema/epidemiología , Eccema/inmunología , Femenino , Humanos , Hipersensibilidad Inmediata/epidemiología , Hipersensibilidad Inmediata/inmunología , Masculino , Prevalencia , Distribución Aleatoria , Rinitis Alérgica Perenne/epidemiología , Rinitis Alérgica Perenne/inmunología , Rinitis Alérgica Estacional/epidemiología , Rinitis Alérgica Estacional/inmunología , Pruebas CutáneasRESUMEN
Aspirin-sensitive rhinitis is characterized by severe perennial nasal congestion and discharge. The study questioned whether this disease, like immunoglobulin E-mediated rhinitis, might be associated with local recruitment and activation of T-lymphocytes, mast cells and eosinophils with parallel increases in "T-helper2-type" cytokines. Nasal biopsies from 10 patients with aspirin-sensitive rhinitis and 12 healthy controls subjects were studied. Nasal mucosal sections were examined by immunohistochemistry in order to determine cell phenotypes and by in situ hybridization to detect cells expressing messenger ribonucleic acid (mRNA) for cytokines. In aspirin-sensitive rhinitis there were increases in total (CD3+) (p=0.05) and activated (CD25+) T-cells (p=0.007), total (major basic protein (MBP) positive) (p=0.004) and activated (monoclonal antibody which recognizes the cleaved form of eosinophil cationic protein (EG2) positive) eosinophils (p=0.003), tryptase+ mast cells (p=0.04) and CD68+ macrophages (p=0.002). Neutrophils and cells expressing human leukocyte antigen-DR were no different. Marked increases were observed in the numbers of interleukin (IL)-5 mRNA+ cells (p=0.004) in aspirin-sensitive patients, whereas lower numbers of IL-4 mRNA+ cells were observed, with a trend for a difference from controls (p=0.07). No differences were observed for either IL-2 or interferon-gamma. In conclusion, in aspirin-sensitive rhinitis there is intense inflammation of the nasal mucosa characterised by T-lymphocytes, eosinophils and mast cells. The predominance of macrophages and disproportionate increase in interleukin-5 compared to interleukin-4 messenger ribonucleic acid expression suggests that factors other than "allergic" mechanisms may be important in this disease.
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Antiinflamatorios no Esteroideos/efectos adversos , Aspirina/efectos adversos , Interleucinas/genética , Leucocitos/patología , Mastocitos/patología , Mucosa Nasal/patología , ARN Mensajero/metabolismo , Rinitis Alérgica Perenne/patología , Ribonucleasas , Adulto , Antígenos CD/metabolismo , Biopsia , Proteínas Sanguíneas/metabolismo , Quimasas , Proteínas en los Gránulos del Eosinófilo , Femenino , Humanos , Inmunofenotipificación , Hibridación in Situ , Interleucinas/biosíntesis , Leucocitos/metabolismo , Macrófagos/metabolismo , Macrófagos/patología , Masculino , Mastocitos/metabolismo , Persona de Mediana Edad , Mucosa Nasal/efectos de los fármacos , Mucosa Nasal/metabolismo , Rinitis Alérgica Perenne/inducido químicamente , Rinitis Alérgica Perenne/metabolismo , Serina Endopeptidasas/metabolismo , TriptasasRESUMEN
The effect of nasal douching in 40 patients with chronic rhinosinusitis was tested, and two different preparations compared: 19 receiving traditional alkaline nasal douche and 21 receiving a sterile sea water spray, in addition to their regular treatment. Douching per se improved endoscopic appearances (p = .009), and quality of life scores (p = .008). These measures did not change in a control group (n = 22) who received standard treatment for chronic rhinosinusitis, but no douche. There were significant differences between the two douching preparations in that the alkaline nasal douche improved endoscopic appearances but not quality of life, whereas the opposite was true for the spray.
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Sinusitis/terapia , Irrigación Terapéutica/métodos , Adolescente , Adulto , Anciano , Enfermedad Crónica , Endoscopía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Cavidad Nasal/patología , Calidad de Vida , Sinusitis/diagnóstico , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
The in vivo effects of benzalkonium chloride, which is a preservative in most nasal sprays and drops, have been investigated in normal human volunteers. Saccharin clearance time was slightly prolonged 10 min after 0.02% benzalkonium chloride was applied, compared to that following 0.9% saline (n = 27, P = 0.04, Wilcoxon test). Sixty-five normal volunteers were randomly assigned to receive saline, fluticasone propionate aqueous nasal spray or placebo (which contained all the ingredients of fluticasone aqueous spray incl. 0.02% benzalkonium chloride, minus the fluticasone propionate) for 2 weeks, two puffs twice a day on a double-blind basis. Symptom scores, acoustic rhinometry, saccharin clearance time and ciliary beat frequency were measured immediately prior to this study and again at 2 weeks. Fifty-eight individuals completed the study with > 80% compliance. There was no significant difference between the three groups in any of the variables tested. Benzalkonium chloride causes slight prolongation of mucociliary clearance shortly after application but has no detectable effect on nasal mucosal function after 2 weeks regular use.
Asunto(s)
Antiinfecciosos Locales/farmacología , Compuestos de Benzalconio/farmacología , Mucosa Nasal/efectos de los fármacos , Adulto , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Depuración Mucociliar/efectos de los fármacos , Factores de TiempoRESUMEN
The new, low-range Ferraris pocket peak flow meter was compared with the well established low-range mini Wright peak flow meter for measuring peak flow rates in children. The peak flow meters were compared by performing three forced expirations using each meter, in 50 children. On average the pocket peak flow meter gave higher readings than the mini Wright, by a mean of 15 l/min. The peak flow rates obtained by the two meters were highly correlated (P < 0.001, r = 0.882 n = 50). In conclusion, the Ferraris pocket peak flow meter is easy and comfortable to use, giving reproducible measurements of peak flow in children.
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Ápice del Flujo Espiratorio , Pruebas de Función Respiratoria/instrumentación , Niño , Preescolar , Diseño de Equipo , Humanos , Monitoreo Ambulatorio/instrumentación , Reología/instrumentaciónRESUMEN
Hyposmia is a neglected symptom in patients with rhinitis. We studied 25 patients presenting with perennial rhinitis. Fifteen patients expressed hyposmia as a significant symptom. University of Pennsylvania smell identification test (UPSIT) and visual analogue scales (VAS) were used to score the symptoms of hyposmia, nasal obstruction and nasal discharge before and after six weeks treatment with betamethasone sodium phosphate drops. Those patients with initial symptoms of hyposmia significantly improved their UPSIT scores (p = 0.00009) and their VAS scores for hyposmia (p = 0.00133). Despite a significant decrease in the sensation of nasal obstruction, the non-hyposmics showed no increase in UPSIT scores after betamethasone therapy. There was no clear correlation between UPSIT results and other symptom scores. The judicious use of betamethasone drops in the treatment of rhinogenic hyposmia can be recommended.
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Betametasona/análogos & derivados , Trastornos del Olfato/tratamiento farmacológico , Rinitis Alérgica Perenne/complicaciones , Adolescente , Adulto , Anciano , Betametasona/administración & dosificación , Betametasona/uso terapéutico , Femenino , Humanos , Instilación de Medicamentos , Masculino , Persona de Mediana Edad , Trastornos del Olfato/etiologíaRESUMEN
Twenty patients with recurrent nasal polyposis but without any history of aspirin sensitivity were given 2000 micrograms of intranasal lysine aspirin to one nostril and saline to the other once a week for periods of up to 15 months. Two patients had increased nasal obstruction following the initial test doses of lysine aspirin and were excluded from the trial proper. In the remainder symptomatic polyp recurrence was delayed compared with the previous experience while on intranasal steroids, with eight patients remaining symptom free at 15 months compared with an expected number of three (P = < 0.05, chi 2 test). Polyp recurrence was bilateral but there was a tendency for the lysine aspirin treated side to have less polyp tissue as assessed by nasendoscopy and by acoustic rhinometry.
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Aspirina/uso terapéutico , Lisina/uso terapéutico , Pólipos Nasales/tratamiento farmacológico , Administración Intranasal , Adulto , Aspirina/administración & dosificación , Combinación de Medicamentos , Humanos , Lisina/administración & dosificación , Masculino , Persona de Mediana Edad , Pólipos Nasales/cirugía , RecurrenciaRESUMEN
The mucociliary escalator is the first line of defence of the upper and lower respiratory tracts (Greenstone and Cole, 1985; Sleigh et al., 1988). Failure of mucociliary clearance is associated with chronic or recurrent respiratory tract infection. Ten patients with chronic rhinosinusitis underwent nasal brushings for the assessment of ciliary beat frequency. In two no beating cilia were seen; in the remainder the mean value was 9.3 Hz +/- 2.3; range 6.1-12.8 Hz (n = 8). Following three months continuous oral antibiotic therapy repeat nasal brushings demonstrated increased ciliary beat frequencies in all patients, mean value 13.7 Hz +/- 1.6; range 11.5-16.3 Hz (n = 10); (p < 0.01; paired t-test). Depression of mucociliary clearance can occur secondarily to chronic infection and is improved by prolonged antibiotics.
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Antibacterianos/uso terapéutico , Cilios/efectos de los fármacos , Rinitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Adolescente , Adulto , Enfermedad Crónica , Cilios/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Depuración Mucociliar/efectos de los fármacos , Rinitis/fisiopatología , Sinusitis/fisiopatología , Factores de TiempoRESUMEN
The aim of the study was to investigate the effect of short-term treatment with fluticasone propionate on the response to nasal allergen challenge in patients with allergic rhinitis. Responses to nasal allergen challenge were assessed subjectively by recording symptom scores on visual analogue scales, and objectively by measuring histamine, PGD2 and LTC4 in nasal lavage and by measuring nasal inspiratory peak flow following challenge. Nasal allergen challenge resulted in an increase in all symptom scores (P < 0.05); an increase in histamine and PGD2 (P < 0.05), and a decrease in nasal inspiratory peak flow at 1 h, 5 h and 7 h following challenge (P < 0.05). The allergen-induced changes in symptom scores, mediator levels and nasal inspiratory peak flow were attenuated by treatment with fluticasone propionate (P < 0.05 for all parameters measured). Post-challenge nasal obstruction was decreased by 45%; sneezing, itching and rhinorrhoea by 73, 78 and 80% respectively in the group as a whole comparing scores whilst on fluticasone propionate with those on no therapy. Fluticasone propionate, 200 micrograms twice daily for 2 weeks is effective in reducing significantly the early and late response to nasal allergen challenge.
Asunto(s)
Androstadienos/uso terapéutico , Antiinflamatorios/farmacología , Antiinflamatorios/uso terapéutico , Rinitis Alérgica Estacional/tratamiento farmacológico , Administración Intranasal , Adulto , Alérgenos/efectos adversos , Androstadienos/administración & dosificación , Androstadienos/farmacología , Antiinflamatorios/administración & dosificación , Femenino , Fluticasona , Glucocorticoides , Histamina/metabolismo , Humanos , Capacidad Inspiratoria/efectos de los fármacos , Leucotrieno C4/metabolismo , Masculino , Persona de Mediana Edad , Líquido del Lavado Nasal/química , Poaceae , Polen , Prostaglandina D2/metabolismo , RadioinmunoensayoRESUMEN
Acoustic rhinometry was used to assess nasal airway patency objectively and was compared with the more established method of anterior rhinomanometry. Ten patients with allergic rhinitis underwent 15 nasal challenges with allergen to which they showed positive skin-prick tests. Responses were assessed by measuring the minimum nasal cross-sectional area (Amin.) using acoustic rhinometry and by measuring nasal airway resistance (NAR) using anterior rhinomanometry. The measurements of Amin. and NAR showed a significant negative correlation. Acoustic rhinometry appears to be superior to anterior rhinomanometry in quantifying the response to nasal allergen challenge and may be particularly useful in patients with initial nasal blockage.
Asunto(s)
Alérgenos , Manometría , Rinitis Alérgica Perenne/diagnóstico , Administración Intranasal , Adolescente , Adulto , Anciano , Alérgenos/administración & dosificación , Humanos , Persona de Mediana Edad , Obstrucción Nasal/etiología , Rinitis Alérgica Perenne/complicaciones , Pruebas CutáneasRESUMEN
Sera from seventy-four adult patients with chronic or recurrent rhinosinusitis (mean duration 10.3 years) were tested for levels of total immunoglobulin and IgG subclasses. Fourteen (19%) had low levels of one of the major immunoglobulin classes and 23 (31%) had one or more IgG-subclass deficiencies, i.e. values less than the mean minus 2 standard deviations of a control population sample. Nineteen patients had low IgG3 levels. The group as a whole showed significantly low mean levels of IgG3, 46.9 +/- 19.5 mg/dl compared to 76 +/- 21 mg/dl for the controls, p < 0.0005 (Student's t-test). Since there was no clinical difference between those with and without IgG3 deficiency, there exists the possibility of an underlying immune defect, possibly involving heavy chain switching, in all these patients.