Allergic and Nonallergic Rhinitis: Can We Find the Differences/Similarities between the Two Pictures?

The diagnostic challenge of rhinitis is to determine the etiology, specifically whether it is allergic or nonallergic. We therefore evaluated the general features of patients with allergic (AR) and nonallergic rhinitis (NAR), as well as health-related quality of life (HRQoL). The study group consisted of 323 patients (201 F/122 M) with a mean age of 31.79 ± 12.64 years. Almost two thirds of the population had AR (63.5%). Neither the demographic characteristics nor the duration of rhinitis was different between the two groups. Total immunoglobulin E was significantly higher in AR. Although both groups displayed a mild-intermittent rhinitis profile, patients with AR had more seasonal and NAR had more perennial symptoms (p = 0.01). Frequency of nasal obstruction was comparable in both groups, whereas patients with AR significantly complained of rhinorrhea (86.8%), followed by nasal obstruction, sneezing, and nasal itching compared with the NAR group. Conjunctivitis and sinusitis were more prominent in the AR than NAR group (p = 0.01). However, the prevalences of asthma and bronchial hyperreactivity were not different, as well as the other allergic or systemic comorbidities. Furthermore, the impairment in HRQoL was similar in both groups, using a generic questionnaire- Short form-36 (SF-36). In conclusion, although the allergy test results still remain the only relevant difference, the diagnosis of NAR is important as it has many differences/similarities with AR and is seen almost half as often as AR in patients with chronic rhinitis.     

sICAM-1 and TNF-α in Asthma and Rhinitis: Relationship with the Presence of Atopy

Background. A genetically determined overproduction of specific immunoglobulin E (IgE) underlies many diseases like asthma or allergic rhinitis. IgE as well as tumor necrosis factor-α (TNF-α), and intercellular adhesion molecule-1 (ICAM-1) play a critical role in the induction and maintenance of inflammation. While the correlation between IgE and atopy is inseparable, little is known about the correlation of atopy with markers of inflammation. Objective. We investigated the relationship between the serum concentrations of TNF-α, soluble ICAM-1 (sICAM-1), and the presence of atopy in patients with persistent rhinitis or asthma. Methods. Serum concentrations of sICAM-1, TNF-α, and total IgE were investigated in 64 adults with persistent allergic rhinitis, 17 subjects with nonatopic rhinitis, 90 patients with asthma, and 21 healthy individuals. Atopy was diagnosed on the basis of positive family history, skin prick tests, and serum IgE concentration. Results. Total IgE concentration was significantly higher in patients with atopic rhinitis or asthma when compared with nonatopic patients and healthy individuals and was the highest in patients suffering from severe atopic asthma who were not treated with systemic glucocorticosteroids. Although there were marked alterations in IgE in atopic and nonatopic patients, there were no significant differences between atopic and corresponding groups of nonatopic rhinitic and asthmatic patients in sICAM-1 and TNF-α concentrations. (sICAM-1 in rhinitis: atopic vs. nonatopic patients: 224.02 and 221.08 ng/ml, respectively, p > .05; in mild/moderate asthma: atopic vs. nonatopic: 306.22 and 326.39 ng/ml, respectively, p > .05; severe asthma without oral corticosteroids therapy: atopic vs. nonatopic: 418.03 and 468.09 ng/ml, respectively, p > .05; and severe asthma with oral corticosteroids therapy: atopic vs. nonatopic: 320.66 and 308.09 ng/ml, respectively, p > .05). Conclusions. Concentrations of sICAM-1 and TNF-α are significantly higher in patients with asthma compared with those observed in patients with rhinitis, but they are independent of the presence of atopy.     

哮喘患者自诉诱发哮喘的感冒并非都是感冒

目的　调查哮喘患者自认为是诱发哮喘的感冒中，有多少人实际上是过敏性鼻炎，并探讨其临床特点及其与哮喘发病的关系。方法　按照预先设计的调查表对１０３ 例患者进行调查，根据是否患过敏性鼻炎将患者分为过敏性鼻炎合并哮喘组（４９ 例）和单纯哮喘组（５４ 例） 详细询问患者每次感冒和哮喘发作的具体症状和相关病史并作体检，同时进行鼻分泌物涂片查嗜酸细胞和过敏原皮肤试验。结果　１０３ 例患者中４９ 例所说的感冒实际上属于过敏性鼻炎，占４７－６％ ；过敏性鼻炎合并哮喘组的哮喘首发年龄明显低于单纯哮喘组，分别为（２８±１３） 岁和（３６ ±１６） 岁，两组比较差异有显著性（Ｐ＜０．０１）；哮喘的好发季节和发作时间与过敏性鼻炎基本一致。结论　（１） 哮喘患者自诉诱发哮喘的感冒并非都是感冒，４７－６％ 的患者所说的感冒实际上是过敏性鼻炎；（２） 过敏性鼻炎与支气管哮喘的发病关系密切；（３）认真鉴别感冒和过敏性鼻炎对于预防哮喘的发生具有重要临床意义。     

Role of nasal saline irrigation in the treatment of allergic rhinitis in children and adults: A systematic analysis

BackgroundThis meta-analysis aims to access the efficacy of nasal saline irrigation in the treatment of allergic rhinitis (AR) in adults and children.MethodsTwo authors independently searched databases up to December 2018. Differences in efficacy between saline irrigation and other treatments were compared. Subgroup analyses of discrepancy in effects between children and adults were performed.Results(1) Saline irrigation vs. no irrigation, in both children and adults groups, saline irrigation showed significant efficacy. (2) Saline + medication vs. medication, in children group, there was no statistical difference of efficacy between saline + medication and medication; in adults group, efficacy of saline + medicine was superior to that of medication. (3) Saline irrigation vs. medication, in children group, there was no statistical difference between efficacy of saline irrigation and medication; in adults group, efficacy of medication was superior to that of saline irrigation. (4) Hypertonic saline vs. isotonic saline, for children, efficacy of hypertonic saline was superior to that of isotonic saline. Additionally, no adults reported adverse events in all trials. Adverse effects were reported during the first nasal irrigation in 20 children, and one child withdrew due to adverse reactions.ConclusionsSaline irrigation can significantly improve symptoms of AR in children and adults. Saline irrigation can serve as a safe adjunctive treatment to medication of AR in adults. Saline irrigation can be an alternative therapy for children and pregnant women with AR. Efficacy of hypertonic saline may be better than that of isotonic saline in treating AR of children.     

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变应性鼻炎(AR)与支气管哮喘均是上、下气道的一种慢性炎症性疾病,在流行病学、病理生理学和治疗方法上存在相似性和相关性,在临床上被称为"同一气道,同一疾病"。AR增加支气管哮喘患者的症状和就诊的需求,不利于支气管哮喘控制,AR对支气管哮喘的影响(ARIA)推荐对AR和支气管哮喘要进行联合诊断并同时治疗。