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PubMedDate not supplied

Treatment of allergic rhinitis: effects of allergic rhinitis and antihistamines on performance.

Antihistamines are the most commonly used drugs for allergic rhinitis, and many antihistamines may cause subclinical side effects which are not noticeable by the patient. These include impaired driving performance, impaired work performance, reduced coordination, reduced motor skills, sleepiness and impaired information processing (arithmetic, verbal, and office skills). The newer nonsedating antihistamines should be used for the treatment of allergic rhinitis because they do not produce these effects. Recent studies have shown that children's learning in school may also be negatively affected by traditional antihistamines, and therefore, school children should definitely be given the nonsedating antihistamines. Not only does the treatment cause some impaired performance, but allergic rhinitis itself may result in changes in the patient's mood affect, and other aspects of personality. Physicians who treat allergic rhinitis should be aware of the potential performance effects of medications that they prescribe and the potential effects of the disease itself on the patient's personality.

Affect↗
PubMed2002

Pregnancy rhinitis and rhinitis medicamentosa.

PURPOSE: To present guidelines for the recognition, management, and referral of pregnancy rhinitis with a goal of improving the quality of the pregnancy experience for women afflicted with this condition. DATA SOURCES: A case study illustrating the presentation of a severe case of pregnancy rhinitis is followed a literature review of etiology, diagnosis, and management strategies. CONCLUSIONS: Pregnancy rhinitis is a condition of clinical importance that is frequently exacerbated by use of intranasal decongestant sprays. The resulting rhinitis medicamentosa exacerbates the nasal obstruction, with resulting sleep disruptions that negatively impact the experience of pregnancy. IMPLICATIONS FOR PRACTICE: Nurse practitioners may miss opportunities to provide support, anticipatory guidance, and symptom relief. Anticipatory guidance that stresses the critical necessity of avoiding nasal spray decongestants, environmental modification, use of intranasal saline, moderate exercise, and nasal strips for subjective relief may have the potential to markedly decrease escalation of the condition to a serious disorder.

Adult↗
PubMed1999

[Non-allergic rhinitis or intrinsic rhinitis? Unusual features of nickel allergy].

The clinical expression of nickel is known for its great diversity, from classical contact eczema to rhinitis, including work-related allergy, and by secondary hyperthermia to a metallic heart valve. Very often, hypersensitivity which may be of type I or type IV is secondary to contact of the hapten with sensitive cells, however some authors have reported the possibility of reactivation of lesions, especially dermatological (urticaria-eczema) by tests of oral ingestion. However, review of the literature does not mention the possibility of O.R.L. problems of the rhinitis type, from rhinosinusitis following ingestion of nickel and the two clinical cases that we report that involve one child of 11 years and one patient of 59 years, both of whom presented a serious rhinitis with a tendency to surperinfection, developing to perennial, where a patch-test to nickel was strongly positive, and who have seen an improvement in their clinical problems with a strict diet without this hapten. This confirms that the need is eventually physiopathological and suggests the necessity to search systematically for a possibility of hypersensitivity to haptens by the patch test technique in rhinitis that is labelled "non-allergic", by a negative reaginic history to pneumoallergens and trophallergens.

Adrenal Cortex Hormones↗
PubMed2000

[Preliminary clinical observation on treatment of chronic rhinitis with rhinitis spray].

OBJECTIVE: To investigate the clinical effect of Rhinitis Spray (RS) in treating chronic rhinitis. METHODS: Eighty patients with chronic rhinitis were divided into three groups, and treated with RS, ephedrine and normal saline respectively. RESULTS: The short-term effective rate in the three groups was 89.3%, 66.7% and 8.0% respectively. RS was effective in alleviating symptoms, increasing IgG level in nasal discharge, improving ventilation of nasal cavity and transfer function of cilia of nasal mucosa obviously. CONCLUSION: The therapeutic effect of RS in treating chronic rhinitis is good.

Administration, Inhalation↗
PubMed1993

Comparison of allergic rhinitis and vasomotor rhinitis patients on the basis of a computer questionnaire.

From 1 July 1990 to 31 December 1991, all patients referred to the Allergy Section of the ENT Department, University Hospital, Lund, Sweden, (n = 678) answered a 134-item questionnaire presented on the screen of a personal computer by pressing Y (for yes) or N (for no) on the keyboard. The objective of this study was to compare the questionnaire responses from patients with allergic rhinitis (AR) with those of patients with perennial nonallergic rhinitis or vasomotor rhinitis (VMR). Nasal blockage was the predominant symptom in the VMR group, whereas the AR patients mainly suffered from eye irritation, sneezing, and, to some extent, rhinorrhea. Concomitant asthma was more prevalent in the AR group than in the VMR group, whose histories were characterized by symptoms associated with airway infections. About 60% of both groups reported problems with such nonspecific airway irritants as cigarette smoke and perfumes. With respect to the diagnostic reliability of the history, in the AR group the order of accuracy (according to the skin prick test results) of reported hypersensitivity to allergens was as follows: cat > timothy > birch > dust mite > mugwort. A history of hypersensitivity to molds as a cause of symptoms was of no diagnostic value. The findings suggest that there are several differences in the medical histories of AR and VMR patients that merit further investigation.

Adult↗
PubMed2000

Effect of topical nasal azelastine on the symptoms of rhinitis, sleep, and daytime somnolence in perennial allergic rhinitis.

BACKGROUND: Recent data suggested that daytime somnolence in patients with allergic rhinitis was secondary to disrupted sleep caused by nasal congestion. Medications, which decreased congestion, would be expected to improve sleep and daytime somnolence. Previously, we demonstrated that nasal steroids improved all three symptoms. The effect of topical nasal antihistamines on these symptoms has yet to be studied. OBJECTIVE: The objective of this 8-week, double-blind, placebo-controlled study was to determine whether topical nasal azelastine was effective at decreasing congestion, daytime somnolence, and improving sleep. METHODS: We recruited 24 subjects with perennial allergic rhinitis and randomized them in a double-blinded, crossover fashion, to receive placebo or azelastine two sprays BID, using Balaam's design. Questionnaires, daily diary, and Epworth Sleepiness Scale were used as tools. The last 2 weeks of each 4-week treatment period were summarized, scored, and compared by PROC MIXED in SAS. RESULTS: The analysis of the Rhinitis Severity Score showed significant improvement only of rhinorrhea in the azelastine group (P = .03). The symptom severity of nasal congestion and daytime somnolence was not significantly different between placebo and azelastine. Subjects considered azelastine effective at improving their sleep (P = .04), but daytime somnolence (P = .06) and congestion (P = .09) were not statistically improved. CONCLUSION: Azelastine is effective in reducing rhinorrhea and improving sleep quality. We were unable to demonstrate that azelastine can significantly reduce the severity of congestion or daytime somnolence.

Administration, Topical↗
PubMed2003

[Advance in therapy of acute rhinitis--comparison of efficacy and safety of xylometazoline in combination xylometazoline-dexpanthenol in patients with acute rhinitis].

BACKGROUND: Acute Rhinitis is based on an inflammation of the nasal mucous membrane with nasal discharge and obstruction. Symptomatic treatment includes local application of decongestants as Xylometazoline and epithelia-protective agents as Dexpanthenol. After proving a synergistic effect of Xylometazoline and Dexpanthenol (Nasic) in patients after nasal surgery, this result should be checked in patients with acute non-allergic rhinitis. PATIENTS AND METHODS: Randomised verum controlled double-blind parallel-group-comparison of five days treatment with nasal sprays containing the combination of Xylometazolin-Dexpanthenol or Xylometazolin. MAIN OUTCOME MEASURE: The assessments of nasal obstruction, rhinorrhea, hyperplasia of nasal concha and redness of the nasal mucous membrane were defined as main-target parameters. RESULTS: 152 outpatients diagnosed with non-allergic, acute rhinitis were included in this study. 151 patients completed the study according to protocol. The superiority of the treatment with Xylometazolin-Dexpanthenol could be proven for the main outcome measures in comparison to Xylometazolin clinically relevant and statistically significant. The result was also validated by the secondary endpoints. The clinically proven efficacy is emphasized by the rhinoscopic findings and safety parameters showing a better tolerability of the combination. CONCLUSION: Accelerating the wound healing corroborates the superiority of the combination and is due to the epithelia protective effect of Dexpanthenol. These results allow especially under socio-economic points of view the conclusion that shorter treatment time with a diminishing risk of a "rebound effect" will improve compliance.

Acute Disease↗
PubMed1990

Platelet-activating factor (PAF)-induced rhinitis and involvement of PAF in allergic rhinitis in guinea pigs.

The effects of inhaled PAF on the guinea pig nasal mucosa were investigated. Intranasal pressure (INP) was recorded as an index of intranasal resistance. To access the capillary premeability of nasal mucosa, exudation of Evans blue into the nasal lavage fluid was determined. Inhalations of histamine and PAF markedly and significantly increased INP and dye exudation into the nasal cavities. The two responses to PAF were about 20-fold and 70-fold stronger than those of histamine, respectively. A PAF antagonist, CV-3988, significantly antagonized both the PAF-induced increases in INP and dye exudation. Indomethacin and OKY-046 had no effect on the PAF-induced responses. FPL-55712 inhibited the PAF-induced increases in INP and dye exudation by 52% and 40%, respectively. Ovalbumin (OA) antigen challenge by inhalation to sensitized guinea pigs resulted in significant increases in both INP and dye exudation. These two responses to 30 mg/ml OA were inhibited by CV-3988 (10 mg/kg, i.v.) by 55% and 40%, respectively. From the above results, it is indicated that: 1) inhalation of PAF evokes rhinitis-like symptoms through activation of PAF receptors, 2) the PAF-induced rhinitis is, in a part, mediated by leukotrienes, and 3) PAF might be involved in allergic rhinitis.

Animals↗
PubMedDate not supplied

The effect of topical nasal fluticasone on objective sleep testing and the symptoms of rhinitis, sleep, and daytime somnolence in perennial allergic rhinitis.

Recent data suggested that daytime somnolence in patients with allergic rhinitis was secondary to disrupted sleep caused by nasal congestion. Medications, which decreased congestion, would be expected to improve sleep and daytime somnolence. Previously, we showed that nasal steroids improved all three symptoms. Presently, we have not performed objective sleep testing to determine if there is a correlation between subjective improvement of congestion, sleep, and daytime somnolence. The objective of this 8-week, double-blind, placebo-controlled study was to determine if topical nasal fluticasone is effective at decreasing subjective congestion and daytime somnolence and improving sleep and if this improvement correlated with a change in overnight sleep testing (polysomnography). We recruited 32 subjects with perennial allergic rhinitis and randomized them in a double-blinded, cross-over fashion, to receive placebo or fluticasone (50 micrograms a spray), 2 sprays each side everyday, using Balaam's design. Questionnaires, quality of life instruments, daily diary, Epworth Sleepiness Scale, and an overnight sleep test with polysomnograms were used as tools. The last 2 weeks of each 4-week treatment period were summarized, scored, and compared by PROC MIXED in SAS. Correlations between arousals on sleep tests and subjective tests were performed. Fluticasone improved subjective sleep when compared with placebo (p = 0.04); however, there was no difference in the apnea/hypopnea index in those that were treated. Daytime sleepiness and fatigue were decreased by > 10% in the treated group; however, this was not statistically significant. However, fluticasone used at approved doses improves subjective sleep in patients with perennial allergic rhinitis without a change in the apnea/hypopnea index.

Administration, Topical↗
PubMed1998

Neuropeptide innervation and neuroendocrine cells in allergic rhinitis and chronic hypertrophic rhinitis.

BACKGROUND: The neuropeptides and neuroendocrine cells are proven to exist in the human nasal mucosa. However, the pathophysiological and neuroimmunological roles of regulatory peptides in human nasal diseases require further investigation. OBJECTIVES: To investigate and compare the functional morphology and quantify the tissue concentration of regulatory peptides in the nasal mucosas of normal, allergic rhinitis (AR) and chronic hypertrophic rhinitis (CHR) subjects. METHODS: Human inferior turbinate mucosa specimens from 28 patients with AR, 25 patients with CHR and 15 patients without any nasal diseases were investigated. Using immunohistochemistry and radioimmunoassays, we detected the presence, distribution and concentrations of various neuropeptides (vasoactive intestinal peptides [VIP], neuropeptide Y [NPY], substance P [SP], calcitonin gene-related peptides [CGRP]) and general neuroendocrine markers (neurone-specific enolase, chromogranin A and somatostatin). Quantitative analysis of the stained fibres and cells were performed using a graphic AutoCAD program. RESULTS: The presence and distribution of NPY, CGRP, and SP nerve fibres and neuroendocrine cells were similar among the three subject groups. AR subjects had significantly higher VIP and SP tissue concentrations. VIP fibres had highest density in AR subjects and these fibers predominantly innervated vessels. In CHR, VIP fibres primarily innervated glands. CONCLUSIONS: VIP and SP may play an important neuroimmunological role in the pathogenesis of AR. VIP may lead to the hypertrophic changes of submucosal glands in the pathogenesis of CHR.

Calcitonin Gene-Related Peptide↗
PubMed1989

Vasomotor rhinitis--atrophic rhinitis: two ends of an autonomic spectrum.

A hypothesis is put forward based on clinical observations and treatment modalities in vasomotor non-allergic rhinitis (V.M.R.) and primary atrophic rhinitis (P.A.R.). The hypothesis postulates that (1) V.M.R. and P.A.R. are two diseases at the ends of an autonomic spectrum (2) The anterior nasal aperture, its dimensions and sensory receptors play a vital role in the etiopathogenesis of both the conditions through reflex autonomic action.

Humans↗
PubMed1995

Use of ipratropium bromide nasal spray in chronic treatment of nonallergic perennial rhinitis, alone and in combination with other perennial rhinitis medications.

To study the long-term safety and effectiveness of ipratropium bromide nasal spray 0.03% in the treatment of nonallergic perennial rhinitis, we administered this medication for 1 year in an open-label trial involving 285 patients. Our intention was to maintain the highest protocol dose possible to gain a clearer picture of the long-term side effect profile of the compound. Ipratropium bromide was well tolerated with no serious side effects in this patient population. It provided a significant improvement in rhinorrhea throughout the year-long trial; only 17 of 285 patients (6%) were considered treatment failures. There was an improvement in patient quality of life, as well as a substantial reduction in the need for other medications (antihistamines, decongestants, and nasal steroids) used to treat perennial rhinitis symptoms.

Adult↗
PubMed2001

A study of the effect of nasal steroid sprays in perennial allergic rhinitis patients with rhinitis medicamentosa.

OBJECTIVE: To determine if rebound congestion can be reduced with concomitant nasal steroid spray usage. STUDY DESIGN AND SETTING: Randomized, double blind, controlled single center study. PARTICIPANTS: Twenty subjects with perennial allergic rhinitis with nasal congestion. INTERVENTION: All subjects received 3 weeks of twice-daily oxymetazoline. After 2 weeks, subjects were randomized to 2 additional weeks of concomitant budesonide aqueous nasal spray (n = 9) or placebo (n = 10). In the sixth week, all sprays were stopped. RESULTS: Both groups showed subjective and objective evidence of rebound congestion 24 hours after cessation of oxymetazoline (P < 0.05). Subjective rebound congestion resolved in 48 hours in the budesonide aqueous nasal spray group but persisted for over 1 week in the placebo group. CONCLUSION: Rebound congestion is objectively present in patients with perennial allergic rhinitis after 3 weeks of oxymetazoline spray. Rebound congestion is reduced by concomitant budesonide aqueous nasal spray use. SIGNIFICANCE: This study supports the common clinical practice of nasal steroid sprays to ameliorate rebound congestion concomitant with and after cessation of topical decongestant sprays.

Adult↗
PubMed2004

Comparison of a generic and a rhinitis-specific quality-of-life (QOL) instrument in patients with house dust mite allergy: relationship between the SF-36 and Rhinitis QOL Questionnaire.

BACKGROUND: Generic and disease-specific quality-of-life (QOL) questionnaires are commonly used in subjects with allergic rhinitis (AR). AR, however, is closely associated with other disorders such as bronchial asthma and atopic dermatitis (AD). These co-morbid associations may have an effect on the inter-relation of generic and disease-specific QOL outcomes and the behaviour of this inter-relation in time. OBJECTIVE: To unravel the inter-relationships between the outcome of a generic instrument (SF-36) and a disease-specific instrument (Rhinitis QOL Questionnaire (RQLQ)). MATERIALS AND METHODS: In the framework of a randomized clinical trial with respect to the efficacy of impermeable bedding covers in house dust mite (HDM) allergy, SF-36 and RQLQ were administered to 224 adults with AR and/or allergic asthma and/or AD at baseline and after 12 months of intervention. Regression analysis and canonical correlation were used to estimate overlap. RESULTS: Overlap between SF-36 and RQLQ domains in terms of explained variance ranged from 6% to 56%. Canonical correlation yielded low coefficients (0.16-0.27). Moreover, both SF-36 and RQLQ scores did not change significantly during the intervention. CONCLUSION: In patients with HDM allergy characterized by co-morbid associations, SF-36 and RQLQ cover different aspects in QOL. It is advocated to use both simultaneously in performing QOL studies.

Adolescent↗
PubMed1997

The pharmacological basis for the treatment of perennial allergic rhinitis and non-allergic rhinitis with topical corticosteroids.

The currently available respiratory topical corticosteroids are all effective at reducing the nasal symptoms of itch, sneezing, rhinorrhoea and obstruction associated with allergic rhinitis. The mechanism of action of corticosteroids is related to their anti-inflammatory activities. They have been documented to prevent fluid exudation and reduce the number of circulating inflammatory cells, including lymphocytes, mast cells, basophils, eosinophils, macrophages, and neutrophils. This occurs through multiple mechanisms, e.g. eosinophil infiltration is suppressed by preventing cytokine production, reducing local mechanisms of tissue infiltration, and decreasing eosinophil survival. Furthermore, corticosteroids also reduce preformed and newly-generated mediators (e.g. histamine, tryptase, prostanoids, leukotrienes), and inhibit production of cytokines and chemokines by inflammatory cells (e.g. IL-1 through IL-6, IL-8, RANTES, TNF-alpha, IFN-gamma and GM-CSF). The currently available corticosteroids differ pharmacologically. Fluticasone propionate appears to have the greatest affinity for the glucocorticoid receptor, and binds more quickly and dissociates more slowly from the receptor compared with other corticosteroids, suggesting a more prolonged duration of action. Its increased specificity for respiratory tissue may lead to greater potency with less potential for systemic adverse effects. Fluticasone propionate has been compared with other corticosteroids in animal models for relative topical and systemic potency, and according to these data, it has the most favourable risk-benefit ratio.

Administration, Topical↗
PubMed1986

Investigation into the pathogenesis of atrophic rhinitis in pigs. I. Atrophic rhinitis caused by Bordetella bronchiseptica and Pasteurella multocida and the meaning of a thermolabile toxin of P. multocida.

In two groups of swine herds, herds with and without clinical AR the presence of Atrophic Rhinitis (AR) correlated with the presence of toxinogenic Pasteurella multocida (PM) and not with the Bordetella bronchiseptica (BB) infection. Six BB- and eighteen PM-strains have been investigated for AR pathogenicity. Broth cultures were injected intradermally in guinea-pigs (GPST) or intranasally in 3-week-old colostrum deprived specific pathogen free (SPF) piglets. The average atrophy of the ventral conchae (AVC) correlated with the GPST in 4 BB-and 7 PM-strains. One BB- and 2 PM-strains were qualified as doubtful, the others as non-AR pathogenic. With AR pathogenic BB-and PM-strains clinical AR could be induced in 3-and 6-week-old piglets. AVC lesions (gradation greater than 1) could be induced with BB in piglets of 6 and with pathogenic PM in 16-week-old piglets. Six of seven AR pathogenic PM-strains resembled Carter-type D and one resembled type A. No significance was found between AR pathogenicity and somatic serotypes. Intranasal instillations of cell-free broth culture filtrates of AR pathogenic PM-strains also caused AR in piglets. These filtrates also caused lethality in piglets and in mice lethalitytest (MLT) and induced a positive GPST. After heating the pathogenic effects of the filtrates disappeared. The name AR toxin has been introduced for this thermolabile, haemorrhagic dermonecrotic (HDNT) fraction of the AR inducing filtrates. The severity of the AR lesions depended on the amount of the AR toxin intranasally instilled in pigs. Cross protecting antibodies obtained in rabbits against the AR toxins of two PM strains could be demonstrated by a toxin neutralisation test in the MLT and the GPST. Broth cultures were injected intradermally in guinea-pigs (GPST) or intranasally in 3-week-old colostrum deprived specific pathogen free (SPF) piglets.

Age Factors↗
PubMed1984

[Genetic nature of atrophic rhinitis in swine. I. The results of a test cross and bacteriological study in atrophic rhinitis in swine].

It is well established that the swine atrophic rhinitis (AR) is controlled by the only gene with two alleles, R and r, the former being a dominant. Our study was designed to determine the role of these factors in appearance of AR of swine among the offspring. Normal and diseased pairs of animals were mated. The heterozygotic (Rr) phenotypically normal but potentially ill hogs and sows were revealed at the farm where AR was spread. The phenotypically normal hogs and sows (RR, Rr) were mated with diseased (rr) or potentially diseased ones, and phenotypically normal heterozygotic (Rr) hogs and sows (control). The diseased sucking-pigs revealed in the litter were removed. It has been established that the sucking-pigs were normal when mating normal homozygotic animals. These sucking-pigs were used to replace the live-stock of sows. When mating normal homozygotic animals with recessive ones, the sucking-pigs were also normal, the normal alleles being dominant. In matings of heterozygotic animals 27.3% of the litter were wry-snouted. However, even healthy heterozygotic animals should not be used for replacing the live-stock, because they have both the normal and recessive alleles. When recessive animals were mated, all sucking-pigs proved to have the symptoms of AR. Such sucking-pigs, together with their parents were necessarily removed.

Animals↗