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[Allergic rhinitis. Coexistent diseases and complications. A review and analysis].

Allergic rhinitis (AR) is rarely found in isolation and needs to be considered in the context of systemic allergic disease associated with numerous comorbid disorders, including asthma, chronic middle ear effusions, sinusitis, and lymphoid hypertrophy with obstructive sleep apnea, disordered sleep, and consequent behavioral and educational effects. The coexistence of allergic rhinitis and asthma is complex. First, the diagnosis of asthma may be confused by symptoms of cough caused by rhinitis and postnasal drip. This may lead to either inaccurate diagnosis of asthma or inappropriate assessment of asthma severity with over treatment of the patient. The term "cough variant rhinitis" is therefore proposed to describe rhinitis that manifest itself primarily as cough that results from postnasal drip. Allergic rhinitis, however, has also a causal role in asthma; it appears both to be responsible for exacerbating asthma and to have a role in its pathogenesis. Postnasal drip with nasopharyngeal inflammation leads to a number of other conditions. Thus sinusitis is a frequent extension of rhinitis and is one of the most frequently missed diagnoses. Allergen exposure in the nasopharynx with release of histamine and other mediators can cause Eustachian tube obstruction possibly leading to middle ear effusions. Chronic allergic inflammation of the upper airway causes lymphoid hypertrophy with prominence of adenoidal and tonsillar tissue. This may be associated with poor appetite, poor growth, obstructive sleep apnea, mouth breathing, pharyngeal irritation and dental abnormalities. Allergic rhinitis is therefore part of a spectrum of allergic disorders that can profoundly affect the well being and quality of life of a child. Prospective cohort studies are required to assess the disease burden caused by allergic rhinitis in childhood, its consequences due to delay in diagnosis and treatment, and to further assess the potential educational impairment that may result. Because allergic rhinitis is part of a systemic disease process, its diagnosis and management require a coordinated approach by the specialist in allergy-immunology-rhinology rather than a fragmented, organ based approach. There are other clinical presentations such as recurrent infections of the upper respiratory tract, as well as pharyngeal and laryngeal disorders.

Adult↗

PubMed1993

[Cytograms of nasal mucosa in seasonal and perennial allergic rhinitis].

The role of cytological analysis of nasal mucosa in seasonal and perennial rhinitis was addressed. The study was carried out in 55 subjects (25 females, 30 males) with seasonal allergic rhinitis and 44 patients (28 females, 16 males) with perennial allergic rhinitis. The cytological examination was carried out during the acute phase of the disease and depend on performing a differential count of epithelial and inflammatory effector cells. Patients with perennial allergic rhinitis demonstrated decreased number of cells in comparison with subjects with seasonal rhinitis. The cytogram of these subjects was characterized by increased number of squamous epithelial cells (27.5%) while in seasonal rhinitis the number did not exceed 17.5% (p < 0.05). In addition the number of neutrophils was higher in perennial allergic rhinitis than in pollinosis (respectively 16.8% and 10.6%). Eosinophils were seen more often in seasonal than perennial rhinitis (27.6%, 17.2%, p < 0.05). The increased number of eosinophils correlated with sneezing in pollinosis (r = 0,543, t = 2,186, p < 0.05). This was not demonstrated in patients with perennial allergic rhinitis. The authors conclude that cytograms of nasal mucosa allow to differentiate perennial from seasonal allergic rhinitis. This test is easy to perform and being non-invasive can be used in diagnosis and monitoring.

Adolescent↗

PubMed2006

Gender and age differences in the relative burden of rhinitis and asthma on health-related quality of life--a Swedish population study.

The aim of this study was to investigate the relative burden of rhinitis and asthma on health-related quality of life (HRQL) as a function of gender and age in the general population. A cross-sectional, general population survey was conducted, comprising 5918 men and women aged 16-64 years. The SF-36 Health Survey was administered by mail, along with questions regarding nasal complaints after 15 years of age and physician-diagnosed asthma. Overall, rhinitis and asthma were each associated with impaired HRQL compared with non-cases and the burden of these illnesses in combination was incremental. In the age group 16-49 years, men and women with rhinitis alone had significantly worse health profiles on most scales than non-cases, while asthmatics, with or without rhinitis, showed further decrements on only a few scales. In the age group 50-64 years, men with rhinitis did not differ from non-cases and no differences were found between asthmatics and rhinitis victims on any scale. In contrast, women aged 50-64 years with rhinitis had significantly worse scores than non-cases on bodily pain and general well-being scales (GH, VT), and asthmatics scored much lower on all scales than those with rhinitis alone. The negative association of rhinitis and asthma with HRQL differs by age and sex in the general population. Women aged 50-64 years with one or both ailments are particularly affected. Such gender and age differences should be taken into consideration in the care and treatment of patients with rhinitis and asthma.

Adolescent↗

PubMed2001

The work impact of asthma and rhinitis: findings from a population-based survey.

Asthma and rhinitis are common chronic conditions that affect adults of working age. Little is known about their relative impacts on work loss and decreased productivity. Using random digit telephone dialing, we carried out a population-survey of adults in Northern California aged 18-50 years. We interviewed 125 persons with asthma (with or without concomitant rhinitis) and 175 persons with rhinitis alone. Study eligibility was based on subject report of a physician's diagnosis of asthma and/or a rhinitis-related condition. Any adult labor force participation since condition onset was lower among those with asthma (88%) than among those with rhinitis alone (97%) (P = 0.002). In contrast, among those still employed, decreased job effectiveness was more frequently reported in the rhinitis group (43 of 121; 36%) compared to those with asthma (14 of 72; 19%) (P = 0.02). Condition-attributed lost work was common in both groups, with more than 20% reporting one or more complete or partial work days lost in the 4 weeks previous to interview. Taking into account age, gender, race, and smoking status, those with asthma were more likely to have no labor force participation after diagnosis (OR = 3.0; 95% CI 1.1-7.7) and less likely to report decreased job effectiveness among those remaining employed (OR = 0.4; 95% CI 0.2-0.9). Excluding subjects from the rhinitis group most likely to have unreported asthma based on past medication use had little impact on these associations. Both asthma and rhinitis negatively affect work productivity. Those with asthma are less likely to be employed at all, while among those remaining on the job, rhinitis is a more potent cause of decreased work effectiveness. The economic impact of asthma and rhinitis and related conditions may be under-appreciated.

Absenteeism↗

PubMed2005

Allergic rhinitis and ear pain in flight.

BACKGROUND: Ear pain is the most common physiologic incident in hypobaric chamber training in the Japan Air Self-Defense Force, and the incidence of ear pain has been gradually increasing. There has been a concomitant increase in the incidence of allergic rhinitis in Japan. We hypothesized that the increased incidence of ear pain may be due to the increased incidence of eustachian tube dysfunction associated with allergic rhinitis. OBJECTIVE: To explore whether there is an association between allergic rhinitis and ear pain experienced in hypobaric chamber training. METHODS: We examined 9 years of training records and noted whether there was a seasonal influence on the occurrence of ear pain in 7047 trainees. In addition, we studied the prevalence of allergic rhinitis among trainees during a representative training year using a questionnaire method, noting association between allergic rhinitis and the occurrence of ear pain. RESULTS: Comprehensive review of training records showed 429 (6.1%) of 7047 trainees complained of ear pain. Ear pain occurred more often in spring than the other 3 seasons. The questionnaire data showed 202 (23.0%) of 878 trainees had allergic rhinitis. Trainees with allergic rhinitis complained of ear pain more often in the spring than trainees without allergic rhinitis. CONCLUSIONS: Active allergic rhinitis is closely associated with the occurrence of ear pain in hypobaric chamber training. A similar phenomenon might occur in an actual flight. Special attention should be paid to not only common cold but also allergic rhinitis in both hypobaric chamber training and actual flights.

Aerospace Medicine↗

PubMed1998

Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology.

This document contains complete guidelines for diagnosis and management of rhinitis developed by the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology and the Joint Council on Allergy, Asthma and Immunology. The guidelines are comprehensive and begin with statements on clinical characteristics and diagnosis of different forms of rhinitis (allergic, non-allergic, occupational rhinitis, hormonal rhinitis [pregnancy and hypothyroidism], drug-induced rhinitis, rhinitis from food ingestion), and other conditions that may be confused with rhinitis. Recommendations on patient evaluation discuss appropriate use of history, physical examination, and diagnostic testing, as well as unproven or inappropriate techniques that should not be used. Parameters on management include use of environmental control measures, pharmacologic therapy including recently introduced therapies and allergen immunotherapy. Because of the risks to patients and society from sedation and performance impairment caused by first generation antihistamines, second generation antihistamines that reduce or eliminate these side effects should usually be considered before first generation antihistamines for the treatment of allergic rhinitis. The document emphasizes the importance of rhinitis management for comorbid conditions (asthma, sinusitis, otitis media). Guidelines are also presented on special considerations in patients subsets (children, the elderly, pregnancy, athletes and patients with rhinitis medicamentosa); and when consultation with an allergist-immunologist should be considered.

Diagnosis, Differential↗

PubMed2006

Defining and classifying occupational rhinitis.

Three categories of rhinitis may occur in the workplace: occupational rhinitis, work-aggravated rhinitis and rhinitis-like conditions. In the present paper, we propose a new definition and a new classification of occupational rhinitis that takes into account mechanisms of induction as well as clinical presentation. In parallel with occupational asthma, occupational rhinitis is defined as a type of rhinitis characterized by intermittent or sometimes permanent nasal airflow limitation due to causes and conditions attributable to the work environment. Occupational rhinitis is classified according to its mechanism of induction as immunological or irritant-induced (non-immunological) rhinitis. Occupational rhinitis of the immunological type can itself be episodic or persistent, whereas the non-immunological type is subdivided into acute, chronic and corrosive.

Humans↗

PubMed1999

Prevalence of rhinitis, pillow type and past and present ownership of furred pets.

BACKGROUND: There has been no previous work investigating the effects of furred pet ownership and pillow type on the risk of developing rhinitis. Recently, unexpected and unexplained associations of asthma with nonfeather pillows have been reported. OBJECTIVE: We developed a questionnaire-based cross-sectional survey to determine whether the past or present ownership of cats or dogs, or the use of nonfeather pillows contributes to the development of seasonal or perennial rhinitis. METHODS: We surveyed 2555 accompanying friends and relatives of patients attending the outpatients departments at one London hospital in 1996. Individuals with rhinitis were defined as those suffering with three or more symptoms of rhinitis either throughout the year (perennial) or for part of the year (seasonal). Present or childhood ownership of cats or dogs was recorded. RESULTS: A strong association was seen with nonfeather pillow use and both seasonal [odds ratio (OR) 1.85; 95% confidence interval (CI) 1.43-2.5] and perennial (OR 2.63; CI 1.67-5. 0) rhinitis. However, more than one-third of rhinitics had changed their pillow type. After restricting the data to exclude subjects who changed their pillow to avoid allergies, the strong association of nonfeather pillow use with perennial rhinitis remained (OR 2.44; CI 1.25-5.0). Adjusting the data to the extreme situation where all former pillow type was feather changes the apparent risk to 0.99 (CI 0.67-1.43). No associations for either seasonal or perennial rhinitis were seen for feather pillows. A weak association of current dog ownership is demonstrated for seasonal rhinitis (OR 1. 47; CI 1.01-2.14). No associations were seen for childhood dog ownership or cat ownership at any time with either type of rhinitis. CONCLUSIONS: Feather pillow use and the ownership of furred pets appears unlikely to increase the risk of developing perennial or seasonal rhinitis. In fact, in contrast with currently held views, there is evidence that the use of nonfeather pillows may increase the risk.

Animals↗

PubMed1997

Non-specific airway hyperresponsiveness in mono-sensitive Sicilian patients with allergic rhinitis. Its relationship to total serum IgE levels and blood eosinophils during and out of the pollen season.

BACKGROUND: Initial attempts to evaluate the association between allergic rhinitis and non-specific bronchial responsiveness has produced conflicting results. In fact, some studies showed a strong correlation and other failed to find an association. However, little is known about the effect of natural specific allergen exposure on the bronchial reactivity of mono-sensitive patients with rhinitis in the southern Mediterranean area, in relation to skin reactivity to allergens, total serum IgE levels and blood eosinophils. OBJECTIVES: The significance of the association between allergic rhinitis, and abnormal airway responsiveness with regard to the pathogenesis of asthma is unclear. For this reason, we have studied non-specific bronchial hyperreactivity, in patients with seasonal allergic rhinitis, with reference to the responsible allergen. The aim of the study was to correlate the responsiveness to bronchoprovocation with methacholine in subjects a with allergic rhinitis during and out of the pollen season with total serum IgE and blood eosinophils. METHODS: Fourty-nine non-smoking patients with clinical diagnosis of allergic rhinitis and mono-sensitive skin-prick tests to pollen allergens were enrolled in the study. Twenty patients suffered from seasonal rhinitis to Parietaria pollen, 15 patients to Gramineae pollen and 14 patients to Olea pollen. In all patients lung function measurements (assessed as response to methacholine), total serum IgE and blood eosinophil counts were measured during and out of the pollen season. RESULTS: During pollen season, 16 out of 49 rhinitis patients demonstrated values of bronchial responsiveness measured as response to inhaled methacholine in the asthmatic range whereas out of the pollen season only eight patients were in the asthmatic range. By analysing the results with reference to the responsible allergen, during the pollen season 15 out of 16 patients were Parietaria-sensitive and out of the pollen season seven out of eight patients. Finally, in Parietaria-sensitive rhinitis bronchial responsiveness significantly correlated, during and out of the pollen season, with total serum IgE and with blood eosinophil counts. CONCLUSIONS: Our results are consistent with the hypothesis that Parietaria is more important than Olea and Gramineae as a risk for developing non-specific bronchial hyperresponsiveness. On the whole, present observations provide further evidence that there is an interrelationship of allergen kind, total serum IgE, eosinophil and bronchial hyperresponsiveness suggesting that they may play a role in the development of bronchial asthma in rhinitis patients.

Adult↗

PubMed2005

Inverse association between Mycobacterium tuberculosis infection and atopic rhinitis in children.

BACKGROUND: The association between Mycobacterium tuberculosis (MTB) infection and atopy remains controversial. AIM: To investigate the association between MTB infection and atopic rhinitis in children living in a high TB incidence area. METHODS: In this cross-sectional study 418 children aged 6-14 years from an established epidemiological research-site in a poor urban community were invited to participate. They were assessed for allergic rhinitis (ISAAC questionnaire) and skin responses to tuberculin and eight environmental allergens. The presence of a BCG scar was documented, intestinal parasites and total and Ascaris lumbricoides-specific IgE levels were measured. Atopic rhinitis was defined, using the new World Allergy Organization (WAO) definition, as reported allergic rhinitis and a positive skin prick test (SPT > or =3 mm) to any allergen. RESULTS: Among the 337 children enrolled 10.4% had allergic rhinitis, 17.5% a positive SPT and 53% a positive tuberculin skin test (TST > or =10 mm). Children with a positive TST were significantly less likely to have recent atopic rhinitis (OR(adjusted) 0.06; 95% CI 0.007-0.5) than those with a negative TST. SPTs were significantly more common in children with negative TST who had recent allergic rhinitis (OR(adj) 34.0; 95% CI 7.6-152.6), but not in children with positive TST and recent allergic rhinitis (OR(adj) 0.6; 95% CI 0.07-5.2). CONCLUSIONS: MTB infection seems to reduce the prevalence of atopic rhinitis, and influences SPT reactivity in children with allergic rhinitis from a high TB incidence area.

Adolescent↗

PubMed2005

Greater risk of incident asthma cases in adults with allergic rhinitis and effect of allergen immunotherapy: a retrospective cohort study.

Asthma and rhinitis are often co-morbid conditions. As rhinitis often precedes asthma it is possible that effective treatment of allergic rhinitis may reduce asthma progression. The aim of our study is to investigate history of allergic rhinitis as a risk factor for asthma and the potential effect of allergen immunotherapy in attenuating the incidence of asthma. Hospital-referred non-asthmatic adults, aged 18-40 years between 1990 and 1991, were retrospectively followed up until January and April 2000. At the end of follow up, available subjects were clinically examined for asthma diagnosis and history of allergen specific immunotherapy, second-hand smoking and the presence of pets in the household. A total of 436 non-asthmatic adults (332 subjects with allergic rhinitis and 104 with no allergic rhinitis nor history of atopy) were available for final analyses. The highest OR (odds ratio) associated with a diagnosis of asthma at the end of follow-up was for the diagnosis of allergic rhinitis at baseline (OR, 7.8; 95%CI, 3.1-20.0 in the model containing the covariates of rhinitis diagnosis, sex, second-hand smoke exposure, presence of pets at home, family history of allergic disorders, sensitization to Parietaria judaica; grass pollen; house dust mites; Olea europea: orchard; perennial rye; and cat allergens). Female sex, sensitization to Parietaria judaica and the presence of pets in the home were also significantly predictive of new onset asthma in the same model. Treatment with allergen immunotherapy was significantly and inversely related to the development of new onset asthma (OR, 0.53; 95%CI, 0.32-0.86). In the present study we found that allergic rhinitis is an important independent risk factor for asthma. Moreover, treatment with allergen immunotherapy lowers the risk of the development of new asthma cases in adults with allergic rhinitis.

Adolescent↗

PubMed2006

Allergic rhinitis and sinusitis in asthma: differential effects on symptoms and pulmonary function.

BACKGROUND: Allergic rhinitis and sinusitis are frequently associated with asthma. The purpose of this study was to determine the impact of self-reported allergic rhinitis and sinusitis on lower airway disease in a large cohort of participants with well-characterized asthma. METHODS: A cohort study of participants in two trials of the American Lung Association-Asthma Clinical Research Centers: 2,031 asthmatics in the Safety of Inactivated Influenza Vaccine in Asthma in Adults and Children (SIIVA) trial and 488 asthmatics in the Effectiveness of Low Dose Theophylline as Add-on Treatment in Asthma (LODO) trial. At baseline, participants reported the presence of allergic rhinitis and sinusitis, and then lung function and asthma control were measured. During the trials, participants were monitored for asthma exacerbations. RESULTS: More than 70% of participants reported either allergic rhinitis or sinusitis. Sinusitis was more common in female patients (odds ratio, 1.46 [SIIVA]), those with gastroesophageal reflux disease (odds ratio, 2.21 [SIIVA]), and those of white race (odds ratio, 1.53 [SIIVA]). Similar associations were seen for allergic rhinitis. LODO participants with allergic rhinitis and sinusitis had increased asthma symptoms and a trend toward more sleep disturbance. Participants with allergic rhinitis had higher baseline lung function than those without allergic rhinitis measured by peak flow (91.2% vs 95.8% in the SIIVA trial). Participants with sinusitis had similar lung function to those without sinusitis. Participants with and without allergic rhinitis had similar exacerbation rates. In the LODO trial only, participants with sinusitis had increased asthma exacerbations (5.68 per patient per year vs 3.72 per patient per year). CONCLUSION: Allergic rhinitis and sinusitis are associated with more severe asthmatic symptoms and, in patients with poorly controlled asthma, more exacerbations but are not associated with low lung function.

Adolescent↗

PubMed2004

The economic burden of allergic rhinitis: a critical evaluation of the literature.

Although a large number of economic analyses of allergic rhinitis have been published, there are relatively few empirically based studies, particularly outside the US. The majority of these analyses can be classified as burden-of-illness studies. Most estimates of the annual cost of allergic rhinitis range from dollars US 2-5 billion (2003 values). The wide range of estimates can be attributed to differences in identifying patients with allergic rhinitis, differences in cost assignment, limitations associated with available data and difficulties in assigning indirect costs (associated with reduced productivity) of allergic rhinitis. Approximately one-third of burden-of-illness studies include direct and indirect costs of allergic rhinitis, about one-third focus on direct costs only, and the remaining one-third focus exclusively on indirect costs due to reduced productivity. Indirect costs attributable to allergic rhinitis were higher in studies only estimating indirect costs (dollars US 5.5-9.7 billion) than in those estimating both direct and indirect costs (dollars US 1.7-4.3 billion). Although there are many economic evaluations of allergic rhinitis treatments in the published medical literature, very few represent formal cost-effectiveness evaluations that compare the incremental costs and benefits of alternative treatment strategies. Those that are incremental cost-effectiveness analyses have several limitations, including small samples, short study periods and the lack of a standardized measure of effectiveness. To date, the medical literature is lacking a comprehensive economic evaluation of general treatment strategies for allergic rhinitis. In undertaking such an analysis, serious consideration must be given to the study population of interest, the choice of appropriate comparators, the perspective from which the analysis is conducted, the target audience, the changing healthcare marketplace and the selection of a measure of effectiveness that incorporates both positive and negative aspects of treatments for allergic rhinitis. Future work would benefit from the development of a consensus on a summary measure of effectiveness that could be used in cost-effectiveness analyses of therapies for allergic rhinitis as well as additional empirical work to measure the association between severity of disease and its impact on worker productivity.

Anti-Allergic Agents↗

PubMed2004

Allergic rhinitis in children : diagnosis and management strategies.

The incidence of allergic rhinitis has been increasing for the last few decades, in keeping with the rising incidence of atopy worldwide. Allergic rhinitis has a prevalence of up to 40% in children, although it frequently goes unrecognized and untreated. This can have enormous negative consequences, particularly in children, since it is associated with numerous complications and comorbidities that have a significant health impact on quality of life. In fact, allergic rhinitis is considered to be a risk factor for asthma. There are numerous signs of allergic rhinitis, particularly in children, that can alert an observant clinician to its presence. Children with severe allergic rhinitis often have facial manifestations of itching and obstructed breathing, including a gaping mouth, chapped lips, evidence of sleep deprivation, a long face, dental malloclusions, and the allergic shiner, allergic salute, or allergic crease. The medical history is extremely important as it can reveal information regarding a family history of atopy and the progression of atopy in the child. It is also important to identify the specific triggers of allergic rhinitis, because one of the keys to successful management is the avoidance of triggers. A tripartite treatment strategy that embraces environmental control, immunotherapy, and pharmacologic treatment is the most comprehensive approach. Immunotherapy has come to be viewed as potentially prophylactic, capable of altering the course of allergic rhinitis. The most recent guidelines for the management of allergic rhinitis issued by the WHO recommend a tiered approach that integrates diagnosis and treatment, in which allergic rhinitis is subclassified both by frequency, as either intermittent or persistent, and by severity, as either mild or moderate to severe. Oral or topical antihistamines and intranasal corticosteroids are the mainstay of pharmacologic therapy for allergic rhinitis, depending upon its severity, and several agents have been approved for use in children aged 5 years old and younger.

Adolescent↗

PubMed2002

[The expression of intercellular adhesion molecules in inferior turbinate mucosa of allergic rhinitis and its significance].

OBJECTIVE: To study the expression of intercellular adhesion molecules in turbinate mucosa of allergic rhinitis and its significance. METHOD: Samples of turbinate mucosa were from 20 cases of chronic hypertrophic rhinitis, 24 cases of non provocation period allergic rhinitis and 20 cases of provocation period allergic rhinitis and their paraffin sections were studied with immunohistochemical technique staining with ICAM 1 and LFA 1 monoclone antibodies. RESULT: Expression of ICAM 1 and LFA 1 were higher in turbinate mucosa of provocation period allergic rhinitis than in chronic hypertrophic rhinitis and non provocation period allergic rhinitis turbinate mucosa(P < 0.01). CONCLUSION: High expression of ICAM 1 and LFA 1 in turbinate mucosa of allergic rhinitis shows that the interaction of ICAM-1/LFA-1 may participate in the inflammatory reaction of allergic rhinitis and may play an important role in the pathogenesis and development of allergic rhinitis.

Adolescent↗

PubMed2003

Effect of topical nasal corticosteroids on patients with chronic fatigue syndrome and rhinitis.

BACKGROUND: Chronic fatigue syndrome (CFS) is a disabling illness of persistent fatigue. Recent studies have shown that patients with CFS have an increased prevalence of nonallergic rhinitis. Inflammation of the nasal passages due to allergic rhinitis can cause nasal congestion resulting in an increased number of sleep disturbances and daytime fatigue. While topical nasal corticosteroids have been shown to alleviate nasal obstruction effectively in patients with rhinitis who do not have CFS, it is unknown whether topical nasal corticosteroids will reduce CFS symptoms. STUDY OBJECTIVE: The purpose of this study is to determine whether topical nasal corticosteroids will reduce daytime sleepiness in patients with CFS and rhinitis. METHODS: Twenty-eight of 31 subjects with rhinitis and a diagnosis of CFS completed the double-blind, randomized, placebo-controlled trial. Two subjects failed screening, and 3 subjects withdrew from the study prior to its completion. Subjects were randomized according to Balaam's crossover design, and one of the following interventions was used for each group in the study: 8-week treatment with a topical nasal corticosteroid, 8-week treatment with a placebo saline spray, 4-week treatment with a topical nasal corticosteroid followed by a 4-week treatment with a placebo saline spray, or a 4-week treatment with a placebo saline spray followed by a 4-week treatment with a topical nasal corticosteroid. Data focusing on rhinitis symptoms, severity of chronic fatigue symptoms, and quality of life were gathered at biweekly office visits and with daily diaries. RESULTS: The results indicated that daytime sleepiness was reduced when patients with rhinitis and CFS were treated with topical nasal corticosteroids. The severity of associated CFS symptoms, specifically fatigue, muscle pain, postexertional fatigue, and daily activity, did not improve with treatment. CONCLUSION: Treating the symptoms of rhinitis in patients with CFS does not appear to alleviate daytime fatigue or associated nasal, musculoskeletal, or cognitive complaints. Therefore, it is unlikely that aggressive treatment of such symptoms with topical nasal corticosteroids will provide significant benefit to patients with CFS who do not have allergic rhinitis. These results indicate that the nonallergic rhinitis seen in patients with CFS may arise from a mechanism other than chronic inflammation.

Administration, Intranasal↗

PubMed2004

Serum eosinophil cationic protein level and disease activity in childhood rhinitis.

In order to investigate clinical markers of disease activity in childhood rhinitis, we compared various laboratory parameters to symptom scores of children with allergic rhinitis and non-allergic rhinitis. We measured the levels of serum total IgE, aeroallergen specific IgE, serum eosinophil cationic protein (ECP), and blood eosinophil counts in 71 children with allergic rhinitis and in 62 children with non-allergic rhinitis. We found a statistically significant difference in peripheral blood eosinophil counts between the allergic rhinitis and non-allergic rhinitis groups. Serum ECP levels were positively related to symptom scores in both groups. Peripheral blood eosinophil counts correlated with symptom scores only in the group with non-allergic rhinitis. The results demonstrated that serum ECP levels are of value in assessing disease activity in both allergic and non-allergic rhinitis, and peripheral blood eosinophil counts may play a role in the evaluation of symptom severity in non-allergic rhinitis.

Adolescent↗

PubMed2006

Diagnosing rhinitis: allergic vs. nonallergic.

Allergic rhinitis, the most common type of rhinitis, generally can be differentiated from the numerous types of nonallergic rhinitis through a thorough history and physical examination. Allergic rhinitis may be seasonal, perennial, or occupational. The most common cause of nonallergic rhinitis is acute viral infection. Other types of nonallergic rhinitis include vasomotor, hormonal, drug-induced, structural, and occupational (irritant) rhinitis, as well as rhinitis medicamentosa and nonallergic rhinitis with eosinophilia syndrome. Since 1998, three large expert panels have made recommendations for the diagnosis of allergic and nonallergic rhinitis. Allergy testing (e.g., percutaneous skin testing, radioallergosorbent testing) is not necessary in all patients but may be useful in ambiguous or complicated cases.

Diagnosis, Differential↗