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PubMed2006

Atishoo! Atishoo! we all fall down!

We report the unusual case of an elderly lady with glaucoma and sneeze syncope because of transient complete atrioventricular block, who had resolution of syncopal and pre-syncopal symptoms following removal of her beta-blocker eyedrops. This case suggests a previously unrecognised pathophysiology in sneeze syncope and illustrates the potential problems associated with the systemic absorption of beta-blocker eyedrops as well as the ingenuity of older patients when participating in the investigation of their own illnesses.

Adrenergic beta-Antagonists↗
PubMed1986

Comparison of levocabastine, a new selective H1-receptor antagonist, and disodium cromoglycate, in a nasal provocation test with allergen.

The effect of intranasal administration of levocabastine, a new selective H1-receptor antagonist, was investigated in a nasal provocation test (NPT) performed with allergens. The NPT allowed a quantitative estimation of the nasal allergic threshold (concentration of allergen necessary to trigger the reaction). In addition, the intensity of the three major rhinitis symptoms (obstruction, rhinorrhea and sneezing) was determined. Twelve adult patients, allergic to grass pollen, underwent a first NPT without pretreatment ('initial NPT'); the NPT was then repeated after the single intranasal administration of either placebo, 8 mg disodium cromoglycate (DSCG) or 0.2 mg levocabastine in a double-blind random order. The NPTs gave reproducible results since both the threshold and symptom intensities were similar in the initial NPT and in the NPT performed after placebo. The reaction threshold increased in 8/12 patients after DSCG (0.05 less than P less than 0.1) and in 9/12 patients after levocabastine (P less than 0.05). Levocabastine clearly inhibited rhinorrhea (P less than 0.001) and sneezing (P less than 0.02) but did not influence the nasal obstruction. DSCG inhibited rhinorrhea only (P less than 0.01). The intranasal administration of levocabastine might be useful in the treatment of allergic rhinitis.

Administration, Inhalation↗
PubMed1994

Comparison of a new antihistaminic and antiallergic compound KW 4679 with terfenadine and placebo on skin and nasal provocation in atopic individuals.

The effects of three oral doses of a new compound KW 4679 thought to have both antihistaminic and antiallergic properties were compared with terfenadine and placebo in a double-blind cross-over trial in 15 volunteers with seasonal allergic rhinitis. Comparison of the effect of the treatments with either 2.5, 5 or 10 mg b.i.d. of KW 4679, 60 mg b.i.d. of terfenadine or placebo was made on the response to histamine and grass pollen skin-prick testing. Nasal provocation testing with grass pollen was performed on the eighth day of treatment. Nasal airway resistance (NAR) was measured using active posterior rhinomanometry and the dose of grass pollen which caused a 200% increase in NAR was determined. The number of sneezes in the first 12 min was counted. Compared with placebo all doses of KW 4679 and terfenadine significantly inhibited the skin weal response to histamine and grass pollen (P < 0.001). The inhibitory effect of KW 4679 on both histamine and allergen induced skin weals was significantly greater than that of terfenadine (P = 0.001 and P = 0.049 respectively). The results of nasal challenges with grass pollen showed that all doses of KW 4679 and terfenadine were effective in reducing sneeze counts (P < 0.001), though there were no significant effects on allergen induced increase in NAR. All three doses of KW 4679 were generally well tolerated. Drowsiness was reported by some of the volunteers on KW 4679 and one volunteer reported drowsiness whilst taking placebo. Slight and reversible rises in AST and ALT concentrations were observed; these were not considered clinically significant.

Adult↗
PubMed2005

Effect of salbutamol on nasal symptoms and mast cell degranulation induced by adenosine 5' monophosphate nasal challenge.

BACKGROUND: In addition to its well-known functional agonism at the level of beta(2) adrenergic receptors on airways smooth muscle cells, salbutamol appears to have additional protective effects, possibly through an inhibition of mast cell activation. OBJECTIVE: The aim of this study is to provide the first evidence in vivo of inhibition of human mast cell activation by salbutamol. METHODS: Nine atopic subjects received placebo and salbutamol (5 mg/mL) 15 min before an adenosine 5' monophosphate (AMP) nasal provocation in a double-blind crossover study design. The nasal lavage was collected from these subjects prior to or 3, 5, 15 or 30 min after the AMP nasal challenge, and concentrations of histamine and tryptase in the nasal lavage were measured. RESULTS: AMP nasal provocation produced considerable sneezing and induced a transient increase in histamine and tryptase release with peak values achieved at 3 min after the challenge in all the subjects studied. Compared with placebo, salbutamol significantly attenuated the release of histamine and tryptase induced by AMP challenge (P=0.048 and 0.020, respectively). Moreover, the AMP-induced sneezing was also inhibited by pre-treatment with salbutamol (P=0.004). CONCLUSIONS: Intranasal salbutamol attenuates nasal symptoms and inhibits histamine and tryptase release caused by AMP nasal provocation thus supporting the hypothesis that salbutamol may play an additional protective role in the airways by inhibiting mast cell activation.

Adenosine Monophosphate↗
PubMed1987

Nasal challenge with serotonin in asymptomatic hay fever patients.

To study the nasal response to serotonin, 14 asymptomatic hay fever patients received intranasal serotonin in increasing doses. Itching and the number of sneezes were noted, and the amount of secretion was measured and assayed for substance P. Nasal airway resistance was recorded by active posterior rhinomanometry. Serotonin induced a dose-dependent increase in nasal itching, number of sneezes and secretion. Substance P was found in 41 of 42 secretions. The median concentration was 10.3 pmol/l (range 0-28.9), and increased parallel to increasing doses of serotonin (P less than 0.001).

Adult↗
PubMed1984

Comparison of the residual virulence of Newcastle disease vaccine strains V4, Hitchner B1 and La Sota.

The clinical response of 7-day-old chickens to Newcastle disease vaccine strains V4, B1 and La Sota administered by the aerosol method was used to study the residual virulence of the strains. Parameters used to assess the severity of the clinical response were the number of sneezes recorded and the weight gain of chickens in the 10 day test period. The demeanour of the chickens was also observed. Strain V4 was less pathogenic for chickens than strain B1 which was less virulent than strain La Sota. Statistically significant differences were recorded in weight gain and the number of sneezes detected in each group. An unexpected mild respiratory disease recorded in chickens dosed with strain V4 may have been associated with administration of virus as a fine particle aerosol.

Animals↗
PubMed1994

Physiologic responses and histamine release after nasal antigen challenge. Effect of atropine.

We enrolled nine allergic subjects in a double blind, placebo-controlled study to examine the effect of premedication with 0.6 mg of atropine on nasal antigen challenge. The challenge consisted of unilaterally stimulating the nasal septum with diluent followed by three increasing doses of antigen and recording responses bilaterally. Sneezes, symptoms, and nasal airway resistance (NAR) were recorded. Secretions were collected using preweighed filter paper discs and histamine was measured. Antigen challenge with the subjects on placebo led to significant dose-dependent increases in sneezes, symptom scores, ipsilateral and contralateral secretion weights, ipsilateral NAR, and total amount of ipsilateral histamine (p < 0.05 versus diluent). Bilaterally applied atropine led to significant inhibition of ipsilateral and contralateral nasal secretions as well as rhinorrhea scores (p < 0.05 versus placebo) but had no significant effect on other parameters. Challenge after atropine premedication led to higher increases in histamine concentration than placebo (p < 0.01). These results suggest that parasympathetically stimulated fluids did not contain histamine and diluted the histamine released by mast cells. To support this hypothesis, we challenged the same subjects with methacholine. The concentration of histamine decreased and was significantly lower than after challenge with antigen (p < 0.01). The data suggest that: (1) histamine is released locally at the site of antigen challenge, (2) the volume of glandular secretions is primarily controlled by parasympathetic stimulation, and (3) the total amount of a mediator recovered in a fixed time interval best reflects the underlying pathophysiologic events.

Adult↗
PubMed1985

Nasal challenge with ragweed pollen in hay fever patients. Effect of immunotherapy.

Challenge of the nasal mucosa of allergic subjects with specific allergen induces not only the expected sneezing and rhinorrhea, but also the appearance in nasal secretions of mediators commonly associated with activation of mast cells or basophils: histamine, leukotrienes, prostaglandin D2 (PGD2), kinins, and TAME ([3H]-N-alpha-tosyl-L-arginine methyl ester)-esterase. To determine whether specific immunotherapy alters mediator release in vivo, nasal pollen challenge was used to compare 27 untreated highly sensitive ragweed (RW)-allergic subjects with 12 similarly sensitive patients receiving long-term immunotherapy (3-5 yr) with RW extract (median dose, 6 micrograms RW antigen E). The two groups were equally sensitive based on skin tests and basophil histamine release. The immunized group had a diminished response as demonstrated by (a) the treated group required higher pollen doses to excite sneezing or mediator release; (b) significantly fewer subjects in the treated group released mediators at any dose (TAME-esterase [P = 0.005], PGD2 [P = 0.04]), and (c) the treated group released 3-5-fold less mediator (TAME-esterase [P = 0.01], and histamine [P = 0.02]).

Adult↗
PubMed1987

Effect of short-term systemic glucocorticoid treatment on human nasal mediator release after antigen challenge.

The effect of systemic glucocorticoid treatment on early- and late-phase nasal allergic reactions after allergen challenge was determined in a double-blind, cross-over study in 13 allergic individuals. The subjects were pretreated for 2 d before challenge with 60 mg prednisone per day or a matching placebo. A previously described model using repeated nasal lavages for measuring mediator release in vivo was utilized. Symptom scores obtained repeatedly before, during, and after the challenge and the number and timing of sneezes were recorded. The mediators measured were histamine. N-alpha-p-tosyl-L-arginine methyl ester (TAME)-esterase activity, kinins, PGD2, and LTC4/D4. Albumin was also measured as a marker of plasma transudation. Blood samples were taken for determination of total number of white blood cells, differential count, and total blood histamine content. No effect of steroid therapy was found on the appearance of symptoms or any of the mediators, except a reduction in kinins, in the early phase of the allergic reaction. However, in the late phase, the prednisone reduced the number of sneezes (P less than 0.01), as well as the level of histamine (P less than 0.05), TAME-esterase activity (P less than 0.05), kinins (P less than 0.05), and albumin (P less than 0.05). Only low levels of leukotrienes were found in the late phase, but the quantities of these mediators seemed to be decreased by the glucocorticoid treatment (P = 0.06). PGD2 did not increase during the LPR and thus was not affected by glucocorticosteroids. The immediate response to a second challenge 11 h after the first was also evaluated. Whereas the appearance of mediators was enhanced over the initial response to the same challenge dose in placebo-treated subjects, this enhancement was abrogated after prednisone treatment. As this dose of drug is known to be clinically effective in treating hay fever, the present study confirms the earlier findings of others that short-term systemic glucocorticoid treatment inhibits the late phase but not the immediate phase of antigen challenge. Furthermore, secondary enhancement of immediate responses is inhibited. This study shows that glucocorticoids inhibit the generation or release of inflammatory mediators during the late reaction and the physiologic response.

Administration, Intranasal↗
PubMed2003

Cytolysis of eosinophils in nasal secretions.

It is still unknown how eosinophils degranulate in nasal mucus. Currently, cytolysis is being reevaluated as the mode of degranulation of eosinophils in allergic nasal mucosa. To examine whether eosinophils migrating to the nasal mucus degranulate by cytolysis, we sampled nasal mucus from 9 patients with nasal allergy and observed it under electron and light microscopes. Both intact and necrotic eosinophils were observed in the nasal mucus. Although the total eosinophil count in the nasal mucus was not correlated with the frequency of sneezes, there was a significant correlation (p = .0025) between the rate of eosinophil lysis and the frequency of sneezes. Whereas extracellular release of eosinophil peroxidase was not detected from the eosinophils with intact cell membranes, large quantities of eosinophil peroxidase were found outside the eosinophils with injured cell membranes. We concluded that eosinophils migrating to the nasal mucus degranulate mainly by cytolysis, and that granular proteins released from the necrotic eosinophils into the nasal mucus are one of the important factors causing hypersensitivity in the nasal mucosa.

Cell Death↗
PubMed2005

Correlation between nasosinusal symptoms and topographic diagnosis in chronic rhinosinusitis.

Rhinitis and sinusitis concern roughly a quarter of the population in the Western world. They are associated with a wide range of symptoms: nasal obstruction, anterior and posterior nasal discharge, sneezing episodes, facial pain or congestion, and taste and smell disorders. The aim of this prospective study was to evaluate the clinical significance of these various symptoms as a function of the topographic diagnosis of chronic rhinosinusitis. The study involved 474 patients with signs of chronic perennial and persistent rhinosinusitis. The disorders of the nasal cavities and paranasal sinuses were classified into three main diagnostic categories: chronic rhinitis, localized sinusitis (mainly, anterior sinusitis), and diffuse rhinosinusitis (ie, nasal polyposis). A principal components analysis was performed. The symptom patterns of the three main clinical entities differed greatly. Most of the following clinical signs--nasal obstruction, anterior and posterior nasal discharge, sneezing, and facial congestion--are found in all diagnostic categories and hold no specific clinical significance. By contrast, four symptoms seem to have a substantial differentiating potential: anosmia and complete loss of flavor for diffuse rhinosinusitis, cacosmia for localized anterior sinusitis, and severe facial pain for localized sinusitis. This study proposes a new analysis of the relationship between symptoms of chronic rhinosinusitis and findings on a sinus computed tomography scan.

Adolescent↗
PubMed1984

Failure of IV atropine to abolish nasal irritation caused by chlormethiazole infusion in elderly patients undergoing spinal anaesthesia.

The efficacy of intravenous atropine in abolishing the nasal irritation of chlormethiazole was assessed. Forty elderly patients undergoing transurethral resection of prostate under spinal anaesthesia were studied. One ml of either atropine sulphate (0.6 mg) or normal saline was administered intravenously in a double-blind fashion 10 minutes prior to infusion of 0.8% chlormethiazole edisylate. A loading infusion of 5 ml X min-1 of the chlormethiazole solution was followed by a variable rate of infusion in order to maintain a predetermined state of sedation--i.e. where the patient lapsed into sleep but was easily awakened to obey commands. Sneezing was the commonest side-effect occurring in 45% and 70% of patients in atropine and saline groups respectively. This was not effectively abolished by IV atropine in incremental doses of 0.6 mg up to 1.8 mg. Because of the sneezing and restlessness, four patients in the atropine group required general anaesthesia to improve operating conditions. These side-effects of chlormethiazole may limit its use as a sedative for surgery in this elderly age group.

Aged↗
PubMed1989

'Asneezia'--some further observations.

Absence of sneezing or inability to sneeze was found in 2.6% of psychiatric patients, although only half complained of the symptom spontaneously. This was the most frequent of a triad of features, the others being infrequent attacks, of coryza and light-headedness. Endogenous depression was the commonest psychiatric diagnosis, followed by schizophrenia, but 'asneezics' differed significantly from controls in their diagnostic distribution; they also tended to be older, poorer, and less educated. The course and outcome of the asneezic triad ran almost parallel to those of the primary psychiatric illness.

Depressive Disorder↗
PubMed2001

Symptoms in health personnel exposed to disinfectants.

BACKGROUND: While the biocidal efficacy of disinfectants available for use in health facilities has been widely investigated, little attention has been paid to their potential side effects to users. OBJECTIVE: To describe the occurrence of symptoms attributable to occupational exposure to disinfectants with emphasis on gluteraldehyde. DESIGN: Exploratory cross-sectional study. SETTING: Kenyan health facilities. SUBJECTS: One hundred and fifteen members of various health cadres. RESULTS: All the respondents reported using disinfectants. Glutaraldehyde-based preparations, either alone or alongside other agents (excluding hypochlorite), were used by 52.2% of the respondents. Hypochlorite-based preparations, either alone or alongside other agents, were used by 18.3%, while cetrimide preparations and ethanol alongside other agents were used by 13% of the respondents. More than sixty two per cent of the respondents had suffered one or more symptoms during the use of these disinfectants. Among the users of glutaraldehyde preparations, the most common symptoms reported were sneezing (38.3%), headache (31.7%), watering of eyes (25%), skin rash (10%) and chronic cough (8.3%). Among users of hypochlorite and cetrimide preparations, the most commonly reported symptoms were sneezing, headaches and watering of eyes. CONCLUSIONS: Our findings suggest possible occupation-related adverse reactions that may be attributed to the use of disinfectants. Awareness of these potential hazards needs to be increased among users and efforts made to introduce techniques to minimise exposure to liquid and vapourised disinfectants. Further studies involving larger sample sizes, are necessary to unequivocally apportion the various symptoms to specific disinfecting agents.

Cross-Sectional Studies↗
PubMed1996

Zinc gluconate lozenges for treating the common cold. A randomized, double-blind, placebo-controlled study.

BACKGROUND: The common cold is one of the most frequent human illnesses and is responsible for substantial morbidity and economic loss. No consistently effective therapy for the common cold has been well documented, but evidence suggests that several possible mechanisms may make zinc an effective treatment. OBJECTIVE: To test the efficacy of zinc gluconate lozenges in reducing the duration of symptoms caused by the common cold. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Outpatient department of a large tertiary care center. PATIENTS: 100 employees of the Cleveland Clinic who developed symptoms of the common cold within 24 hours before enrollment. INTERVENTION: Patients in the zinc group (n = 50) received lozenges (one lozenge every 2 hours while awake) containing 13.3 mg of zinc from zinc gluconate as long as they had cold symptoms. Patients in the placebo group (n = 50) received similarly administered lozenges that contained 5% calcium lactate pentahydrate instead of zinc gluconate. MAIN OUTCOME MEASURES: Subjective daily symptom scores for cough, headache, hoarseness, muscle ache, nasal drainage, nasal congestion, scratchy throat, sore throat, sneezing, and fever (assessed by oral temperature). RESULTS: The time to complete resolution of symptoms was significantly shorter in the zinc group than in the placebo group (median, 4.4 days compared with 7.6 days; P < 0.001). The zinc group had significantly fewer days with coughing (median, 2.0 days compared with 4.5 days; P = 0.04), headache (2.0 days and 3.0 days; P = 0.02), hoarseness (2.0 days and 3.0 days; P = 0.02), nasal congestion (4.0 days and 6.0 days; P = 0.002), nasal drainage (4.0 days and 7.0 days; P < 0.001), and sore throat (1.0 day and 3.0 days; P < 0.001). The groups did not differ significantly in the resolution of fever, muscle ache, scratchy throat, or sneezing. More patients in the zinc group than in the placebo group had side effects (90% compared with 62%; P < 0.001), nausea (20% compared with 4%; P = 0.02), and bad-taste reactions (80% compared with 30%; P < 0.001), CONCLUSION: Zinc gluconate in the form and dosage studied significantly reduced the duration of symptoms of the common cold. The mechanism of action of this substance in treating the common cold remains unknown. Individual patients must decide whether the possible beneficial effects of zinc gluconate on cold symptoms outweigh the possible adverse effects.

Administration, Oral↗
PubMed1996

Effectiveness and safety of intranasal ipratropium bromide in common colds. A randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To determine the tolerability and clinical effectiveness of intranasal ipratropium bromide for the treatment of symptoms of common colds. DESIGN: Multicenter, double-blind, randomized trial. SETTING: 3 university student health services. PATIENTS: 411 previously healthy persons 14 to 56 years of age who had cold symptoms that had lasted for no more than 36 hours, rhinorrhea subjectively judged to be of at least moderate severity, and documented nasal discharge of at least 1.5 g over a 1-hour observation period. INTERVENTION: Either 1) ipratropium bromide nasal spray 0.06% in buffered salt solution, two 42-micrograms sprays per nostril administered by metered pump spray; 2) control nasal spray, which consisted of buffered salt solution; or 3) no treatment. Treatments were self-administered three or four times daily during waking hours for 4 days. After receiving their morning dose, patients stayed at the study center for 6 hours on study day 1 and 3 hours on study day 2; symptom severity was recorded and nasal mucus discharges were collected and weighed hourly during these periods. RESULTS: Ipratropium recipients had 26% less nasal discharge than controls (P = 0.0024) and 34% less nasal discharge than untreated patients (P = 0.0001). Severity of rhinorrhea as judged subjectively was reduced in ipratropium recipients by 31% compared with controls and by 78% compared with untreated patients (P = 0.0001 for both comparisons). In addition to being associated with reductions in daily assessments of the severity of rhinorrhea (P < or = 0.003), ipratropium was associated with reduced sneezing on study days 2 (20% difference; P = 0.03) and 4 (30% difference; P = 0.02) but not with reduced nasal congestion compared with the control spray. Ipratropium was generally well tolerated but was associated with higher rates of blood-tinged mucus (16.8% in the ipratropium group compared with 3.6% in the control group; P = 0.01) and nasal dryness (11.7% in the ipratropium group compared with 3.6% in the control group; P = 0.021) than the control spray. Patient assessments of the overall effectiveness of treatment were more favorable for ipratropium than for the control spray (P < or = 0.026) or for no treatment (P < or = 0.002) on each day of inquiry (study days 1, 2, and 5). CONCLUSIONS: Intranasal ipratropium bromide provides specific relief of rhinorrhea and sneezing associated with common colds.

Administration, Intranasal↗
PubMed1999

Multifunctional laryngeal motoneurons: an intracellular study in the cat.

We studied the patterns of membrane potential changes in laryngeal motoneurons (LMs) during vocalization, coughing, swallowing, sneezing, and the aspiration reflex in decerebrate paralyzed cats. LMs, identified by antidromic activation from the recurrent laryngeal nerve, were expiratory (ELMs) or inspiratory (ILMs) cells that depolarized during their respective phases in eupnea. During vocalization, most ELMs depolarized and most ILMs hyperpolarized. Some ILMs depolarized slightly during vocalization. During coughing, ELMs depolarized abruptly at the transition from the inspiratory to the expiratory phase. In one-third of ELMs, this depolarization persisted throughout the abdominal burst. In the remainder ("type A"), it was interrupted by a transient repolarization. ILMs exhibited a membrane potential trajectory opposite to that of type A ELMs during coughing. During swallowing, the membrane potential of ELMs decreased transiently at the onset of the hypoglossal burst and then depolarized strongly during the burst. ILMs hyperpolarized sharply at the onset of the burst and depolarized as hypoglossal activity ceased. During sneezing, ELMs and ILMs exhibited membrane potential changes similar to those of type A ELMs and ILMs during coughing. During the aspiration reflex, ELMs and ILMs exhibited bell-shaped hyperpolarization and depolarization trajectories, respectively. We conclude that central drives to LMs, consisting of complex combinations of excitation and inhibition, vary during vocalization and upper airway defensive reflexes. This study provides data for analysis of the neuronal networks that produce these various behaviors and analysis of network reorganization caused by changes in dynamic connections between the respiratory and nonrespiratory neuronal networks.

Animals↗
PubMedDate not supplied

[Sensitivity and specificity of a questionnaire about respiratory symptoms similar to asthma].

INTRODUCTION: Questionnaires are an epidemiological instrument to detect patients with asthma. MATERIALS AND METHODS: Worldwide standardized questionnaires were selected, taking the most important points for making the diagnosis of asthma. A questionnaire was applied to outpatients who attend to pulmonary disease service. The answers were compared with a "gold standard" proposed, consisted in clinical screening and pulmonary function tests. STATISTICAL ANALYSIS: Kappa coefficient, sensitivity, specificity and predictive values were obtained, with intervals of confidence of 95%. RESULTS: The questionnaires were applied to 120 patients, 70.83% women, the answering percentage was 99%. Mean age was 32 years with a range of 24-40. In 62.5% patients there was already a previous diagnosis of asthma. Positive Familial history was present in 65.83, cough in 85%, dyspnea in 80.83%, sneezes in 53.33% and wheezes in 77.5%. The was of kappa coefficient for previous medical diagnosis 0.96%, followed by positive familial history, wheezes and cough in 0.90%. The greatest specificity was for wheezes, dyspnea and previous medical diagnosis. The greatest specificity for previous medical diagnosis was wheezes and sneezes. CONCLUSIONS: The use of questionnaires for respiratory symptoms similar to asthma can be an option to detect groups of high risk.

Adult↗