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PubMed1992

Azelastine reduces allergen-induced nasal response: a clinical and rhinomanometric assessment.

The effect of azelastine 2 mg b.d. p.o. for 10 days on grass pollen-induced nasal responses in 16 patients with grass pollen allergic rhinitis has been assessed. The study was a double blind, randomized, placebo controlled, crossover trial, with a 10-14 day wash-out period. Patients were challenged with grass pollen before and after placebo and azelastine. The response was assessed by measurement of nasal resistance using active posterior rhinomanometry, by weighing nasal secretions, and by counting sneezes. The sensation of nasal obstruction was assessed with a visual analogue scale. After measurement of baseline total nasal resistance, doubling doses of allergen were sprayed into both nostrils at 15 min intervals until the nasal resistance was doubled. Cumulative doses of allergen that doubled prechallenge nasal resistance, numbers of sneezes and the amounts of nasal secretions were similar before azelastine as well as before and after placebo (cumulative dose, mean, (microgram): 2.3, 4.2 and 2.1 respectively, N.S.). After azelastine, the cumulative dose of allergen was increased (7.3 micrograms), and nasal secretions and the number of sneezes were decreased. The visual analogue scores were similar before and after azelastine as well as before and after the placebo. It is concluded that azelastine reduced the allergen-induced nasal responses.

Adult↗
PubMed1997

Effects of a cysteinyl leukotriene antagonist, ONO-1078 (pranlukast), on total airway resistance after antigen challenge in sensitized guinea pigs.

OBJECTIVE AND DESIGN: To define the role of leukotriene (LT) in allergic rhinitis, we examined the effects of a cysteinyl (Cys) LT antagonist (ONO-1078, pranlukast). MATERIAL: Actively sensitized Dunkin-Hartley guinea pigs. TREATMENT: ONO-1078 (pranlukast), 3-100 mg/kg p.o. 1 h before antigen challenge. METHODS: Nasal symptoms (sneezing, nasal scratches), changes of total airway resistance (TAR by plethysmography) and eosinophil infiltration into the nasal mucosa were determined following topical antigen (OA) challenge. Dunnet's test (TAR and symptoms) and the Mann-Whitney U-test (eosinophils) were applied. RESULTS: Control animals showed bi-phasic nasal responses, peaking 10 min and 240 min after the topical antigen challenge, respectively. While the early-phase response was characterized by nasal symptoms of sneezing and scratching accompanied by the increase in TAR, the late-phase was characterized by an increase in TAR accompanied by eosinophil infiltration into nasal mucosa. The nasal symptoms (sneezing and scratching) were not inhibited by pretreatment with ONO-1078 at doses up to 100 mg/kg (p.o., n = 15). Although early peak responses of TAR were not affected with even the highest dose (30 mg/kg, p.o., n = 6), late-phase TAR peak response (control: 174.8 +/- 8.2%, n = 6) were significantly inhibited by 10 mg/ kg (142.7 +/- 15.8%; p < 0.05, n = 6) and 30 mg/kg (118.0 +/- 6.6%; p < 0.01, n = 6) of ONO-1078 (p.o.). In addition, the eosinophil infiltration induced by the antigen was not inhibited by ONO-1078 (30 and 100 mg/kg, p.o., n = 6). CONCLUSIONS: Our results suggest that Cys LT may play an important role in the late-phase increase in TAR in the guinea pig model of allergic rhinitis.

Administration, Topical↗
PubMed1992

Inhibition of mediator release during the early reaction to antigen.

A nasal lavage model and a new filter paper disk model have been used to measure biologic and physiologic responses to antigen challenge in patients with allergic rhinitis. Pretreatment of subjects with cetirizine reduced the number of sneezes induced by antigen challenge but did not significantly reduce levels of histamine or prostaglandin D2 in a double-blind, placebo-controlled trial with the lavage model. Pretreatment with 60 or 300 mg of terfenadine did significantly reduce levels of histamine, kinin, albumin, and TAME-esterase activity in a double-blind, placebo-controlled study with this model. Again with the nasal lavage model, a double-blind, placebo-controlled comparison of pretreatment with 60 mg of terfenadine or 10 mg of loratadine showed that both agents significantly reduced sneezing. Both drugs also lowered levels of antigen-induced histamine and TAME-esterase, but only terfenadine did so significantly. In a double-blind, placebo-controlled study, the new disk method showed that terfenadine reduced sneezing but not nasal congestion in eight patients with allergic rhinitis. Terfenadine significantly reduced the weight of nasal secretions on both sides of the nose and significantly reduced histamine on the ipsilateral side.

Albumins↗
PubMed1994

Effect of experimental rhinovirus 39 infection on the nasal response to histamine and cold air challenges in allergic and nonallergic subjects.

To determine whether a viral upper respiratory tract infection can alter the responsiveness of the nasal mucosa, paired intranasal histamine and cold air challenge sessions were performed before and after (8 to 13 days) experimental rhinovirus infection in 18 nonallergic subjects and 20 subjects with seasonal allergic rhinitis. The nasal response to the challenges was measured as symptom scores for rhinorrhea and congestion, counts for sneezing, weight for expelled secretions, and inspiratory conductance for nasal patency. For both sessions, a greater response was observed in allergic subjects for sneezing, symptoms of rhinorrhea and congestion, secretion weights provoked by histamine challenge, and secretion weights provoked by cold air challenge when compared with the nonallergic subjects. A comparison of the responses to the paired challenge sessions showed greater responses for sneezing, secretion weight and rhinorrhea to histamine and for secretion weight to cold air challenges performed after rhinovirus infection. No differences were observed between allergic and nonallergic subjects with respect to the degree of enhanced responsiveness secondary to viral infection. These results document an increased responsiveness of the nose to these stimuli during the postsymptomatic period of a rhinovirus infection in both allergic and nonallergic subjects.

Adolescent↗
PubMedDate not supplied

Triamcinolone acetonide aqueous nasal spray for the treatment of patients with perennial allergic rhinitis: a multicenter, randomized, double-blind, placebo-controlled study.

In this multicenter, randomized, double-blind, placebo-controlled study, 178 patients with symptoms of perennial allergic rhinitis (PAR) were treated with either triamcinolone acetonide (TAA) Aqueous nasal spray (220 micrograms once daily) or placebo for 4 weeks. Symptoms of PAR (nasal stuffiness, nasal discharge, sneezing, nasal index, and nasal itching) were evaluated throughout the treatment period through the use of patient diaries. In addition, both patients and physicians completed independent global evaluations of treatment efficacy at the conclusion of the study. TAA Aqueous provided clinically and statistically (P < or = 0.05) greater improvements in nasal stuffiness, sneezing, nasal index, and nasal itching over the 4-week study period than did placebo. Significant improvements in sneezing (P = 0.022) were observed as early as the first day (within 12 to 16 hours based on treatment in the morning and assessment of symptoms at bedtime), and in the nasal index (P = 0.009) by the third day after treatment with TAA Aqueous. Patients' and physicians' global evaluations of overall efficacy were concordant: 65% of patients rated their nasal symptoms greatly or somewhat improved with TAA Aqueous compared with 48% in the placebo group; physicians rated 66% of patients as having greatly or somewhat improved symptoms with the study drug compared with 48% of patients who received placebo. Adverse events were mild and the incidences were comparable for both groups; no significant changes in vital signs or clinical laboratory parameters were observed. This study demonstrated that TAA Aqueous administered once daily was well tolerated and provided relief of PAR symptoms in adults and adolescents.

Administration, Intranasal↗
PubMedDate not supplied

Mucociliary activity and the diving reflex.

It has previously been shown that mucociliary activity in the rabbit maxillary sinus is immediately increased after short-term exposure to such airway irritants as cigarette smoke and ammonia vapor. This increase is mediated through the stimulation of capsaicin-sensitive nerve endings. Besides producing the mucociliary effect, these irritants inhibit breathing, a response characteristic of the diving reflex in mammals. Whether an increase in mucociliary activity is part of the diving reflex was investigated by injecting 0.5 mL water into the nasopharynges of anesthetized rabbits. Mucociliary and respiratory responses were compared with the effects of mechanical stimulation (ie, rotating an intranasal catheter until sneezing occurred). Water challenge produced an increase in mucociliary activity of 21.6% +/- 2.4%, a response that began approximately 10 seconds after injection. Mucociliary acceleration was completely blocked by atropine, indicating a cholinergic mechanism, but was unaffected by pretreatment with capsaicin. The respiration rate was inhibited by about 45% after challenge with water. Pretreatment with atropine and capsaicin had no effect on this reduced respiratory rate. Mechanical stimulation of the nasal mucosa accelerated mucociliary activity. This response appeared approximately 4 seconds after stimulation was begun, and occurred simultaneously with the onset of sneezing. The peak increase was 22.0% +/- 2.1%. Sneezing was followed by an increase in the respiration rate of about 40%. Pretreatment with atropine or capsaicin had no effect on respiratory responses, but did inhibit mucociliary acceleration, suggesting that the response is mediated through cholinergic effector neurons after activation of capsaicin-sensitive nerve endings.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Perennial allergic rhinitis: clinical efficacy of a new antihistamine.

Nasal itching, sneezing, and rhinorrhea are troublesome symptoms in patients with perennial allergic rhinitis. Most first-generation H1-receptor agonists achieve a 50% reduction in these symptoms, but their benefits are frequently offset by annoying anticholinergic and sedative side effects. Cetirizine is a major metabolite of hydroxyzine that has little anticholinergic activity and causes significantly less sedation. In addition, it can be given once a day. In placebo-controlled comparisons with terfendadine, both active drugs were comparably effective and significantly better than placebo in relieving sneezing, rhinorrhea, and nasal itching. In a multicenter, double-blind comparison with placebo, both cetirizine, 10 and 20 mg given once daily, were similarly effective and superior to placebo in reducing the overall symptoms of rhinitis. In another multicenter, double-blind study, cetirizine was comparable with diphenhydramine and significantly superior to placebo in reducing total symptom severity, sneezing, rhinorrhea, and ocular itching. The safety of cetirizine was demonstrated in all studies. Cetirizine tended to be less sedating than diphenhydramine.

Benzhydryl Compounds↗
PubMed1996

Attenuation of allergen-evoked nasal responses by local pretreatment with exogenous neuropeptide Y in atopic patients.

BACKGROUND: Nasal obstruction and rhinorrhea present in allergic rhinitis are at least partly influenced by neuropeptides released from sensory, parasympathetic, and sympathetic nerves. Neuropeptide Y (NPY) is co-localized with norepinephrine in sympathetic perivascular nerves. NPY is released with norepinephrine on sympathetic nerve stimulation and produces long-lasting vasoconstriction of the nasal vascular bed. In addition to vasoconstriction, there is evidence to suggest that NPY modulates the release of transmitters originating from parasympathetic and sensory nerves by acting on prejunctional receptors. Putative therapeutic application of NPY in rhinitis has been recently suggested because intranasal administration of exogenous NPY in human beings reduces nasal airway resistance and vascular permeability without affecting submucosal gland secretion. OBJECTIVE: The aim of this study was to determine whether intranasal pretreatment with exogenous NPY could influence the functional responses to subsequent allergen challenge. METHODS: A randomized double-blind, three-way, crossover, placebo-controlled study was performed in 13 patients with allergic rhinitis. Pretreatments with NPY (20 nmol), oxymetazoline hydrochloride (20 nmol), or saline solution (NaCl 0.9%) were administered in one nostril 5 minutes before nasal challenge with grass pollen allergen (10,000 standardized quality units). The number of sneezes and the subjective evaluation of nasal itching obstruction, and rhinorrhea were recorded. Nasal airway resistance was measured by anterior rhinomanometry, and nasal secretions were weighed. Mean arterial pressure and heart rate were recorded by noninvasive methods. RESULTS: The number of sneezes, nasal itching, and subjective rhinorrhea evoked by the allergen were similar after the three pretreatments. Subjective and objective increases in nasal airway resistance and mucus production induced by the allergen were significantly (p < 0.01) reduced after NPY pretreatment when compared with saline solution or oxymetazoline pretreatment. Mean arterial pressure and heart rate were not changed. CONCLUSIONS: Local pretreatment with exogenous NPY reduces nasal obstruction and mucus secretion evoked by allergen challenge in allergic patients without modification of local itching and number of sneezes.

Administration, Intranasal↗
PubMed1999

Comparison of the effects of terfenadine with fexofenadine on nasal provocation tests with allergen.

BACKGROUND: Fexofenadine, the hydrochloride salt of terfenadine active metabolite, is a nonsedative, noncardiotoxic antihistamine derivative for the treatment of allergic rhinitis. OBJECTIVE: We sought to compare the effects of terfenadine and fexofenadine on nasal provocation tests with allergen. METHODS: A preliminary provocation test (screening phase) was performed in 25 patients with a history of seasonal allergic rhinitis to grass pollen to determine the combined nasal reaction threshold, which was defined as 2 of the 3 following criteria: (1) at least a 40% decrease in peak nasal inspiratory flow and/or a 30% decrease in minimal cross-sectional area as measured by acoustic rhinometry, nasal secretions of 0.5 g, and 5 to 10 sneezes per minute. Patients were then included into a double-blind, randomized, 2-way crossover study to receive terfenadine or fexofenadine 120 mg 2 hours before provocation. Rhinorrhea, sneezing, peak nasal flow, and minimal nasal cross-sectional area, as well as symptom scores for nasal congestion and itchiness, were recorded at each allergen concentration up to the reaction threshold. The whole study was performed out of allergy season. RESULTS: Fexofenadine was as potent as terfenadine in limiting pruritus and nasal congestion. Rhinorrhea and sneezing were better controlled by fexofenadine than by terfenadine. Overall, the allergen concentration necessary to reach the combined reaction threshold was increased after treatment with both drugs. Comparison between screening and each treatment phase indicated that the shift in allergen concentration to reach the reaction threshold was significantly greater after fexofenadine than after terfenadine (P =. 033). CONCLUSION: After oral administration, fexofenadine provided better protection than terfenadine against the immediate allergic reaction.

Adult↗
PubMed1999

Histamine and tryptase in nasal lavage fluid after allergen challenge: effect of 1 week of pretreatment with intranasal azelastine or systemic cetirizine.

BACKGROUND: Antihistamines (H1-receptor antagonists) act by competitive antagonism of histamine at H1-receptors. In addition, high concentrations of some antihistamines inhibit allergen-induced histamine release from mast cells in vitro. OBJECTIVE: The purpose of this study was to determine the effect of intranasal azelastine or systemic cetirizine (both potent antihistamines) on the allergen-induced release of mast-cell mediators from the human nasal mucosa in vivo. METHODS: Patients allergic to birch pollen (n = 11) and control subjects not allergic to birch pollen (n = 5) were included in a randomized, double-blind, placebo-controlled, 3-way crossover study outside the pollen season. Each subject was treated with azelastine nasal spray 0.14 mg per nostril twice daily, cetirizine tablets 10 mg every day, or placebo for 1 week using a double-dummy design. At the end of each treatment period, nasal allergen challenges were performed, and the number of sneezes were counted. In addition, nasal lavage fluid was collected, and the levels of mast-cell mediators (histamine and tryptase) were measured. RESULTS: The allergen challenge of patients allergic to pollen produced sneezing and a significant increase in the levels of histamine and tryptase. The challenge of subjects not allergic to pollen produced no such response. Azelastine and cetirizine significantly reduced allergen-induced sneezing and the associated increase in histamine and tryptase levels. No significant differences were found between the azelastine and cetirizine treatments. CONCLUSION: Pretreatment with azelastine or cetirizine inhibits the allergen-induced release of mast-cell mediators from the human nasal mucosa. Our results are consistent with the hypothesis that both antihistamines reduce mediator release from nasal mucosa mast cells in vivo. However, further studies are necessary to test this hypothesis.

Administration, Intranasal↗
PubMed2006

Impact of azelastine nasal spray on symptoms and quality of life compared with cetirizine oral tablets in patients with seasonal allergic rhinitis.

BACKGROUND: In fall 2004, the first Azelastine Cetirizine Trial demonstrated statistically significant improvements in the total nasal symptom score (TNSS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores with the use of azelastine nasal spray vs oral cetirizine in patients with seasonal allergic rhinitis (SAR). OBJECTIVE: To compare the effects of azelastine nasal spray vs cetirizine on the TNSS and RQLQ scores in patients with SAR. METHODS: This 2-week, double-blind, multicenter trial randomized 360 patients with moderate-to-severe SAR to azelastine, 2 sprays per nostril twice daily, or cetirizine, 10-mg tablets once daily. The primary efficacy variable was the 12-hour reflective TNSS (rhinorrhea, sneezing, itchy nose, and nasal congestion). Secondary efficacy variables were individual symptom scores and the RQLQ score. RESULTS: Azelastine nasal spray and cetirizine significantly improved the TNSS and individual symptoms compared with baseline (P < .001). The TNSS improved by a mean of 4.6 (23.9%) with azelastine nasal spray compared with 3.9 (19.6%) with cetirizine. Significant differences favoring azelastine nasal spray were seen for the individual symptoms of sneezing and nasal congestion. Improvements in the RQLQ overall (P = .002) and individual domain (P < or = .02) scores were greater with azelastine nasal spray. Both treatments were well tolerated. CONCLUSIONS: Azelastine nasal spray and cetirizine effectively treated nasal symptoms in patients with SAR. Improvements in the TNSS and individual symptoms favored azelastine over cetirizine, with significant differences for nasal congestion and sneezing. Azelastine nasal spray significantly improved the RQLQ overall and domain scores compared with cetirizine.

Administration, Intranasal↗
PubMed2005

Safety and efficacy of olopatadine hydrochloride nasal spray for the treatment of seasonal allergic rhinitis to mountain cedar.

BACKGROUND: A nasal spray containing the antiallergy agent olopatadine hydrochloride is being developed for the treatment of seasonal allergic rhinitis (SAR) to mountain cedar. OBJECTIVE: To evaluate the safety and efficacy of 2 concentrations of olopatadine nasal spray vs placebo nasal spray in patients with SAR to mountain cedar. METHODS: This was a multicenter, randomized, double-blind, placebo-controlled study. After a 3- to 21-day placebo run-in, 677 patients aged 12 to 81 years were randomized to receive 0.4% or 0.6% olopatadine or placebo, 2 sprays per nostril twice daily for 2 weeks. Patients evaluated morning and evening reflective and instantaneous nasal symptoms (sneezing, stuffy nose, runny nose, and itchy nose, which compose the total nasal symptom score [TNSS]) and ocular symptoms. RESULTS: Olopatadine spray (0.4% and 0.6%) was statistically significantly superior to placebo for percentage change from baseline in overall reflective and instantaneous TNSSs. Also, 0.6% olopatadine was statistically significantly superior to placebo for reducing the reflective and instantaneous assessments of sneezing, runny nose, itchy nose, stuffy nose, itchy eyes, and watery eyes. Olopatadine spray exhibited a safety profile comparable with that of placebo. CONCLUSIONS: Olopatadine nasal spray (0.4% and 0.6%) provided statistically significant improvements in allergic rhinitis symptoms compared with placebo regarding TNSSs and individual symptoms, including congestion, itchy and runny nose, sneezing, and itchy and watery eyes, in patients with SAR to mountain cedar. Olopatadine nasal spray administered twice daily was safe and well tolerated in adolescents and adults.

Administration, Inhalation↗
PubMed2005

Assessment of pre and postoperative symptomatology in patients undergoing inferior turbinectomy.

UNLABELLED: Partial inferior turbinectomy is a procedure directed to treat nasal obstruction secondary to hypertrophy rhinitis. This study evaluates the impact of this procedure in the quality of life of the patients, analyzing the improvement of other symptoms such as rhinorrhea, nasal itching and sneezing after six months of the surgical procedure. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Forty-nine patients submitted to turbinectomy associated or not with septoplasty, received questionnaires to grade the intensity of symptoms. Through the comparison of severity of symptoms before and after six months of the surgery, it was possible to evaluate the degree of improvement of each symptom. The results were classified as null, good, moderate and great, and we subtracted postoperative score from the preoperative score. RESULTS: The nasal obstruction presented good or great results in 98% of the patients. For rhinorrhea, the surgery has resulted in good or great improvement in 49% of the cases. Sneezing presented good or great results in 81.6% of the patients and, nasal itching, 45%. CONCLUSION: The study showed that the clinical benefits obtained with the partial inferior turbinectomy are not limited to nasal obstruction, extending also to others symptoms of rhinitis, mainly in relation to sneezing crisis.

Adolescent↗
PubMed2000

Allergic rhinitis: not purely a histamine-related disease.

Allergic rhinitis is an inflammatory disorder of the nasal mucosa typified by the symptoms of nasal itch, sneeze, anterior nasal secretions, and nasal blockage. These symptoms arise from the interaction between mediators and neural, vascular, and glandular structures within the nose. Nasal itch, sneezes, and rhinorrhoea are predominantly neural in origin, while nasal obstruction is predominantly vascular. Nasal biopsy studies show accumulation of eosinophils within the lamina propria and epithelium and an increase in tissue and cell surface basophils in both seasonal and perennial allergic rhinitis. These cells are in an activated state. Within the epithelium, increased numbers of mast cells, T cells and Langerhans' cells, which induce T-cell activation, are found. The accumulation of these cells can be linked to chemokine and cytokine generation by the epithelial cells themselves. Thus, the tissue cell recruitment is orchestrated by activated mast cells, T cells, and epithelial cells, with the recruited tissue eosinophils also contributing to their persistence at this site through autocrine mechanisms. Mast cells generate an array of mediators including histamine, tryptase, leukotrienes, and prostaglandins. Histamine is also generated by basophils. Eosinophils and basophils contribute to the leukotriene synthesis within the tissue. Histamine nasal insufflation induces nasal itch, sneeze, and rhinorrhoea as well as nasal blockage, thereby reproducing all the symptoms of allergic rhinitis. These effects are primarily mediated by H1-receptors, and H1-receptor antagonists are a prominent treatment. Antagonism of histamine at these receptors reduces symptoms by about 40-50%, with the greatest effect on the neurally mediated responses. Thus, histamine is a major mediator of allergic rhinitis, but not the sole contributor. Nasal insufflation with leukotrienes, prostaglandins, or kinins is associated with the development of nasal blockage. These mediators act primarily on the nasal vasculature and, in this respect, leukotrienes are potent mediators. Leukotrienes also induce plasma protein exudation, which contributes to the anterior nasal secretions. Studies with combination products have suggested that modifying the effects of both leukotrienes and histamine has complementary effects in relieving nasal symptoms, indicating that both these mediators are relevant to disease expression.

Eosinophils↗
PubMed2004

Clinical study of the therapeutic efficacy and safety of emedastine difumarate versus terfenadine in the treatment of seasonal allergic rhinitis.

OBJECTIVE: Emedastine is a new H1-receptor antagonist endowed with potent and selective antihistamine activity. The aim of this study was to evaluate the therapeutic efficacy and tolerability of emedastine difumarate (CAS 87233-62-3) in Caucasian patients in the treatment of seasonal allergic rhinitis as compared to terfenadine (CAS 50679-08-8). METHODS: A total of 130 patients suffering from grass pollen allergic rhinitis were randomly assigned to 14 days treatment with either emedastine difumarate (2 mg b.i.d.) or terfenadine (60 mg b.i.d.) in a double-blind, randomised, crossover design. Primary efficacy parameter was a Total Severity Symptom Score, including among symptoms nasal congestion, sneezing, rhinorrhea, nasal/throat/palate itching, eye itching and lacrimation. Safety was assessed on routine laboratory tests and recording vital signs and adverse events (AEs). RESULTS: Emedastine 2 mg b.i.d. was significantly more effective than terfenadine 60 mg b.i.d. in reducing Total Symptom Severity Score (p = 0.0258). This statistical significant difference was also obtained in controlling sneezing and rhinorrhea (p = 0.003). Moreover, both the physician and patients indicated emedastine as the preferred therapy (p < 0.01). Forty-seven drug related AEs were reported for emedastine (= 51.07 %) and 53 for terfenadine (64.15 %), most of them involving the CNS. CONCLUSION: The results of study show that emedastine difumarate is more effective than terfenadine in the symptomatic management of seasonal allergic rhinitis and is particularly active in controlling the main nasal symptoms, such as sneezing and rhinorrhea; it is safe and well tolerated in this therapeutic indication, while related AEs are less if compared to those displayed by terfenadine.

Adolescent↗
PubMed1998

Late phase response in nasal mucosa closely correlated with immediate phase reaction and hyperreactivity to histamine.

It has been suggested that the onset of the late phase response (LPR) and hyperreactivity to non-specific stimuli occurs in the lower airway. However, its relationship in the nose has not yet been studied. This study was designed to examine the mechanism of LPR and the relationship between LPR and hyperreactivity. A total of 25 Japanese cedar pollinosis patients participated in this study. On the first visit, the frequency of sneezes, weight of nasal discharge, and the nasal airway resistance (NAR) were time-dependently measured without antigen challenge. The histamine reactivity was observed after 12 h. The same protocol was used during the second to fourth visits. The frequency of sneezes, weight of nasal discharge, and NAR were measured continuously for 12 h after antigen challenge, and nasal reactivity to histamine was observed. The percent change of NAR during immediate phase response (IR) and during LPR showed a significant correlation. The frequency of sneezes and weight of nasal discharge induced by histamine were both significantly higher in the positive than in the negative LPR group. These results suggest that the chemical mediators and inflammatory cells inducing nasal swelling during IR cause, directly or indirectly, nasal swelling during LPR, and induce hyperreactivity to histamine.

Acute-Phase Reaction↗
PubMed2003

Radiofrequency for the treatment of allergic rhinitis refractory to medical therapy.

OBJECTIVES/HYPOTHESIS: The ideal treatment for allergic rhinitis refractory to medical therapy is still lacking. The aim of the study is to evaluate the efficacy of turbinate surgery with radiofrequency for the treatment of allergic rhinitis that is unresponsive to medical therapy. STUDY DESIGN: A prospective, nonrandomized clinical study. METHODS: From February 2000 to April 2002, 108 consecutive patients (45 men and 63 women [mean age, 29.5 y]) with allergic rhinitis refractory to medical therapy who underwent radiofrequency turbinate surgery were enrolled in the study. Postoperative follow-up ranged from 12 to 26 months. A standard 0-to-10 visual analogue scale with an anchor was used to assess the pain and the allergic symptoms, including nasal obstruction, rhinorrhea, sneezing, itchy nose, and itchy eyes, preoperatively and postoperatively at the end of weeks 1 and 2 and months 1, 3, 6, and 12 after surgery. Statistical analysis was determined by repeated measures of ANOVA. RESULTS: None of the 108 patients had obvious discomfort other than mild numbness over the premaxillary area (24 of 108 [22.2%]) during operation. Also, no adverse reactions including bleeding, infection, adhesion, or a worsening of allergic symptoms were encountered. One hundred one patients were included in the final statistical analysis. Only nine patients reported no improvement at all after treatment. The response rate of radiofrequency turbinate surgery for allergic rhinitis refractory to medical therapy was 91.1% (92 of 101). At 1 year after the treatment, the degree of nasal obstruction had changed on the visual analogue scale (mean +/- SD) from 6.84 +/- 2.09 to 2.47 +/- 1.60, an improvement of 63.9%. The degree of rhinorrhea had changed from 5.74 +/- 2.75 to 2.57 +/- 2.31, an improvement of 55.2%. The degree of sneezing had changed from 5.30 +/- 2.80 to 2.59 +/- 2.13, an improvement of 51.1%. The degree of itchy nose had changed from 3.74 +/- 3.16 to 1.82 +/- 2.27, an improvement of 51.3%. The degree of itchy eyes had changed from 3.17 +/- 3.09 to 1.68 +/- 2.38, an improvement of 47.0%. The visual analogue scale scores for nasal obstruction, rhinorrhea, sneezing, itchy nose, and itchy eyes decreased significantly with time, from preoperative scores to scores at 1 year after surgery. Other additional effects and improvements, including headache, lumpy throat, night cough, and tinnitus, were also reported by the patients. Most of the patients stated that they would consider repeating this procedure if necessary and would recommend the new method to their friends with the same problems. CONCLUSIONS: The study demonstrates that radiofrequency appears to be an effective and safe tool for treating allergic rhinitis with poor response to medical therapy. In the future, radiofrequency has the potential to be one of the most popular surgical modalities for the treatment of allergic rhinitis refractory to medical therapy.

Adolescent↗
PubMed1992

Inhibition of histamine-induced nasal obstruction by cetirizine in allergic rhinitis.

This double-blind randomized crossover placebo-controlled study was designed to assess objectively the nasal antihistamine effect of cetirizine in patients with allergic rhinitis and control subjects. Nasal challenge was performed by nebulization of increasing doubling doses of histamine (0; 0.04 to 1.28 mg/nostril) in six patients with allergic rhinitis and six control subjects on cetirizine (2 x 10 mg daily for 3 days) or placebo. Sneezings were counted and nasal obstruction was assessed by subjective scoring and by objective measurement of nasal airway resistance by posterior rhinomanometry. Histamine induced sneezing and a dose-dependent increase in nasal airway resistance and in perceived sensation of obstruction. Responses were greater in patients with allergic rhinitis compared with controls, although of borderline significance for nasal obstruction. Cetirizine totally abolished sneezing and significantly reduced increase in nasal airway resistance and perceived sensation of nasal obstruction both in normal and rhinitic subjects. Our results demonstrate by an objective measurement the nasal antihistamine effect of cetirizine. We propose this simple provocation test to assess the time-course of the effect of antihistamines and to compare the relative potency of related compounds.

Adult↗