Análisis de la curva flujo-volumen en niños y adolescentes con rinitis alérgica sin asma / Analysis of the fow-volume curve in children and adolescents with allergic rhinitis without asthma

Introducción. Existen evidencias epidemiológicas, funcionales y patológicas que vinculan las vías aéreas superior e inferior, reconocidas clínicamente como una vía aérea única. Los pacientes con rinitis alérgica sin asma podrían presentar anormalidades espirométricas subclínicas. Objetivos. Describir los resultados de las curvas fujo-volumen en un grupo de pacientes con rinitis alérgica sin asma y analizar las posibles asociaciones entre las variables antropométricas, clínicas y bioquímicas con los resultados anormales de las pruebas espirométricas. Población y métodos. Estudio observacional descriptivo, en el que se incluyeron niños y adolescentes de entre 6 y 18 años con síntomas de rinitis alérgica sin asma. Se estableció la edad, el sexo, el índice de masa corporal y la duración de la rinitis por la historia clínica. Se realizaron pruebas cutáneas con alérgenos, espirometría por curva fujo-volumen, determinación de eosinóflos en la sangre y la secreción nasal, e IgE sérica total. Resultados. Se estudiaron 84 pacientes; 21 (25%; IC 95% 15,1 a 34,8) presentaron alguna variable espirométrica alterada. El índice FEV1/FVC fue el más afectado (10/84; 12% IC 95% 4,3 a 19,4). El análisis de regresión logística múltiple determinó que la alteración espirométrica se asoció con el número de eosinóflos en la sangre (OR 1,00229; IC 95% 1,00022 a 1,00436; p= 0,03) y el índice de masa corporal (OR 1,31282; IC 95% 1,08611 a 1,58685; p= 0,0049). Conclusiones. Los resultados muestran la presencia de alteraciones espirométricas en un importante porcentaje de niños y adolescentes con rinitis alérgica sin asma. El recuento absoluto de eosinóflos en la sangre y el índice de masa corporal estarían asociados a la alteración subclínica de la función pulmonar.

Introduction. There is epidemiological, functional and pathologic evidence that relates upper and lower airways, clinically known as a single respiratory tract. Patients with allergic rhinitis without asthma may present subclinical abnormal spirometry parameters. Objectives. To describe the results of the fow-volume curve in a group of patients with allergic rhinitis without asthma and analyze the possible associations between anthropometric, clinical and biochemical outcome measures with abnormal spirometry results. Population and Methods. Observational, descriptive study including children and adolescents aged 6 to 18 years old with symptoms of allergic rhinitis without asthma. Age, gender, body mass index and duration of rhinitis were determined as per the subject's medical record. Allergen skin tests, fow-volume curve spirometry, determination of eosinophil count in blood and in nasal secretions, and total serum IgE were performed. Results. A total of 84 patients were studied; 21 (25%; 95% CI: 15.1-34.8) presented at least one altered spirometry outcome measure. The FEV1/FVC ratio was the most affected outcome measure (10/84; 12%; 95% CI: 4.3-19.4). The multiple logistic regression analysis determined that spirometry alterations were associated with the number of blood eosinophils (OR: 1.00229; 95% CI: 1.00022-1.00436; p= 0.03) and the body mass index (OR: 1.31282; 95% CI: 1.08611-1.58685; p= 0.0049). Conclusions. Our results showed spirometry alterations in a considerable percentage of children and adolescents with allergic rhinitis without asthma. The blood eosinophil count and the body mass index could be associated with a sub-clinical alteration of pulmonary function.

Parental smoking patterns and their association with wheezing in children

OBJECTIVE: To investigate parental smoking patterns and their association with wheezing in children. METHODS: We performed a case-control study that included 105 children between 6 and 23 months of age who were divided into two groups: cases (children with 3 previous episodes of wheezing) and controls (healthy children without wheezing). The children's exposure to cigarette smoking was estimated using a questionnaire completed by the mothers and by the children's urinary cotinine levels. RESULTS: Based on both the questionnaire results and cotinine levels, exposure to cigarette smoking was higher in the households of cases in which the incidence of maternal smoking was significantly higher than that of paternal smoking. Children in this group were more affected by maternal smoking and by the total number of cigarettes smoked inside the house. Additionally, the questionnaire results indicated that the risk of wheezing was dose dependent. The presence of allergic components, such as atopic dermatitis and siblings with allergic rhinitis and asthma, greatly increased the odds ratio when wheezing was associated with cotinine levels. CONCLUSION: Children exposed to tobacco smoke have an increased risk of developing wheezing syndrome. This risk increases in association with the number of cigarettes smoked inside the house and the presence of other allergic components in the family. .

Correlação entre a resistência nasal e diferentes parâmetros da rinometria acústica em crianças e adolescentes com e sem rinite alérgica / Correlation between nasal resistance and different acoustic rhinometry parameters in children and adolescents with and without allergic rhinitis

Rinometria acústica e rinomanometria são importantes técnicas de avaliação da função nasal. Ainda não está definido em que extensão suas variáveis se correlacionam. OBJETIVO: Avaliar as relações entre a resistência nasal (RN) e parâmetros da rinometria acústica em crianças e adolescentes com rinite alérgica e controles. MÉTODO: Vinte pacientes com rinite alérgica e 20 controles foram avaliados. RN, volumes (V4, V5, V2-5) e menores áreas transversais (MC1, MC2) foram mensurados em três momentos: basal, após indução de obstrução nasal e após descongestionante tópico. RESULTADOS: No grupo rinite, a RN se correlacionou significantemente com todos os volumes (V5: r = -0,60) e com MC2. Nos controles, MC1 foi o parâmetro com melhor correlação com a RN no momento basal (r = -0,53) e após descongestionante. Na análise conjunta dos dados, V5 foi o que apresentou as melhores correlações, no momento basal (r = -0,53), quando obstruído (r = -0,58) e após descongestionante (r = -0,46). CONCLUSÕES: Nossos dados demonstram haver correlação negativa e significante entre os valores de rinometria acústica e RN. Em geral, os volumes apresentaram melhor correlação com a RN do que as menores áreas transversais. V5 foi a variável com melhor correlação no grupo com rinite alérgica e na análise conjunta.

Acoustic rhinometry and rhinomanometry are important tests used to assess nasal function. The degree to which the parameters of these tests are correlated is yet to be established. OBJECTIVE: This paper aimed to study the correlations between nasal resistance (NR) and acoustic rhinometry parameters in children and adolescents with allergic rhinitis and controls. METHOD: Twenty patients with allergic rhinitis and 20 controls were enrolled. NR, volumes (V4, V5, V2-5), and minimal cross-sectional areas (MC1, MC2) were measured in three moments: baseline, after induction of nasal obstruction and after topical decongestant administration. RESULTS: Patients with allergic rhinitis had significant correlation between NR and all volumes (V5: r = -0.60) and with MC2. Among controls, MC1 was the parameter with the strongest correlation with NR at baseline (r = -0.53) and after decongestant administration. In the combined analysis, V5 had the highest correlation coefficients at baseline (r = -0.53), after obstruction (r = -0.58) and after decongestant (r = -0.46). CONCLUSIONS: Our data showed that NR and acoustic rhinometry parameters have negative and significant correlations. Nasal volumes are, in general, better correlated than minimal cross-sectional areas. V5 was the parameter with the highest correlation in the rhinitis group and in the combined analysis.

Avaliações objetiva e subjetiva da obstrução nasal em crianças e adolescentes com rinite alérgica / Objective and subjective assessments of nasal obstruction in children and adolescents with allergic rhinitis

OBJETIVO: Relacionar a avaliação objetiva da obstrução nasal por rinometria acústica (volume dos cinco primeiros centímetros da cavidade nasal) e rinomanometria anterior ativa (resistência nasal total) com a avaliação subjetiva (escore de obstrução). MÉTODO: Participaram do estudo 30 pacientes (7 a 18 anos) com rinite alérgica persistente e 30 controles. O escore foi referido para cavidade nasal total e narinas em separado. As três variáveis foram mensuradas nos momentos basal e após indução de obstrução nasal. RESULTADOS: Houve correlações significantes e negativas entre resistência e volume nasal em todos os grupos e situações de avaliação, exceto para narina mais obstruída, grupo controle, pós-obstrução. Para a cavidade nasal total, não houve correlação significante entre as variáveis objetivas e subjetiva, exceto entre escore e volume na cavidade nasal total no grupo controle pós-obstrução. Na narina mais obstruída, houve correlação significante e negativa para escore e resistência e significante e positiva para escore e volume nasal no grupo total, momento basal. Não houve diferença nítida nos coeficientes de correlação entre pacientes e controles, e estes não se alteraram após a indução de obstrução nasal. CONCLUSÕES: Avaliação objetiva da obstrução nasal não apresentou correlação significativa com a avaliação subjetiva na cavidade nasal total, mas sim na avaliação unilateral. Houve correlação entre avaliações objetivas. Rinite alérgica ou obstrução nasal aguda não interferiram na correlação entre as avaliações objetiva e subjetiva da obstrução nasal. Sugere-se utilidade no acréscimo de métodos objetivos para avaliação da obstrução nasal em pesquisas e, na sua impossibilidade, avaliação das narinas em separado.

OBJECTIVE: To correlate objective assessment of nasal obstruction, as measured by acoustic rhinometry (volume of the first 5 cm of the nasal cavity) and active anterior rhinomanometry (total nasal airway resistance), with its subjective evaluation (obstruction scores). METHOD: Thirty patients, aged 7 to 18 years, with persistent allergic rhinitis and thirty controls were enrolled. The obstruction score was reported for the whole nasal cavity and for each nostril separately. The three variables were measured at baseline and after induction of nasal obstruction. RESULTS: There were significant and negative correlations between resistance and nasal volume in all groups and scenarios, except for the most obstructed nostril, in the control group, post-obstruction. For the whole nasal cavity, there was no significant correlation between objective and subjective variables except between score and total nasal cavity volume in the control group, post-obstruction. Regarding the most obstructed nostril, we found a significant negative correlation between score and resistance and a significant positive correlation between score and volume for the total group at baseline. There were no clear differences in the correlation coefficients found in patients and controls. The correlation coefficients did not change after induction of nasal obstruction. CONCLUSIONS: Objective assessment of nasal obstruction did not correlate significantly with subjective evaluation for the nasal cavity as a whole, but there was a correlation for unilateral assessments. There was correlation between the objective evaluations. Allergic rhinitis and acute induction of nasal obstruction did not affect the correlation between objective and subjective assessments of nasal obstruction. Addition of an objective method for evaluation of nasal obstruction could be useful in the research setting; if no such method can be used, each nostril should be evaluated separately.

Remodelamento das vias aéreas inferiores e superiores: [revisão] / Remodeling of the lower and upper airways: [revision]

Remodelamento pode ser definido como modelar novamente ou de forma diferente, reconstruir. Trata-se de um aspecto crítico do processo de reparação de lesões em todos os órgãos, representando um evento dinâmico de produção e degradação de matriz, em reação a inflamação, levando à reconstrução normal do tecido ou à formação de um tecido patológico. OBJETIVO E MÉTODO: Comparar os dados existentes em literatura entre o remodelamento de vias aéreas inferiores e superiores. RESULTADO: Asma é uma doença inflamatória crônica associada a remodelamento de vias aéreas. Na rinite alérgica, outra doença inflamatória crônica, o remodelamento é ainda pouco entendido. Apesar de a inflamação ser similar na rinite alérgica e asma, a extensão patológica do remodelamento nasal, assim como sua repercussão clínica, pode ser diferente dos brônquios. CONCLUSÃO: O remodelamento nas vias aéreas superiores ocorre em menor intensidade que nas vias inferiores, mas é aparente que a estrutura da mucosa nasal de pacientes com rinite não é normal.

Remodeling is defined as modeling again or differently, as reconstructing. Remodeling is a critical aspect of wound repair in all organs; it represents a dynamic process that associates the production and degradation of matrix in reaction to inflammation. This leads to normal reconstruction or a pathologic process. AIM AND METHODS: To compare data in the current literature on upper and lower airways. RESULTS: Asthma is a chronic inflammatory disease associated with abnormal airways remodeling. In allergic rhinitis, another chronic inflammatory disease, remodeling is still poorly understood. Even though inflammation is similar in allergic rhinitis and asthma, the pathologic extent of nasal remodeling, as well as its clinical consequences, might be different from those in bronchi. CONCLUSION: Remodeling occurs less in upper airways compared to lower airways; it is apparent, however, that the structure of the rhinitic nose is not normal.

Alterações funcionais do sistema estomatognático em pacientes com rinite alérgica / Functional alterations of the stomatognathic system in patients with allergic rhinittis

A respiração oral pode acarretar alterações estruturais e funcionais do sistema estomatognático. As causas mais frequentes da respiração oral são as obstruções nasais e/ou faríngeas. Dentre as obstruções nasais, a rinite alérgica é uma doença cuja incidência vem aumentando...

The mounth breathing can cause structural and functional alterations on the stomatognathic system. The most frequent causes of oral respiration nasal and/or pharyngeall obstruction . Amongst nasal obstructions, allergic rhinitis is a disease which has been...

Assessment of olfactory status in allergic and non-allergic rhinitis patients.

A study undertaken to assess the olfactory acuity in allergic (group I) and non-allergic rhinitis (group II) patients in comparison with age and sex matched controls (group III). Patients presenting with atleast three of the five cardinal symptoms of rhinitis i.e. rhinorrhoea, sneezing, itching, headache and nasal obstruction were grouped as non-infective rhinitis and further divided into allergic rhinitis (group I, n = 20) and non-allergic rhinitis (group II, n = 20) based on nasal smear cytology positivity or negativity for eosinophils respectively. Detailed Ear, Nose and Throat examination was carried out in both the groups and peripheral blood samples were analysed for total, differential leukocyte and absolute eosinophil counts using standard techniques. In all the three groups the olfactory thresholds for 5 odorants i.e. musk (M), formalin (F), camphor (C), asafoetida (A, 10% aqueous solution) and oil of peppermint (P, 20%) were evaluated for testing musky, pungent, camphorous, putrid and minty odours respectively by the method described by Elsberg and Levy for quantitative olfactometry. The results indicated elevation of olfactory thresholds (delta %, calculated taking control values as 100%) for 4 or 5 odorants in group I and group II patients respectively as compared with controls (group I: delta % for P--89.6%; M--116.4%; A--55.8%; P < 0.001; C--73.1%; P < 0.02; F--26.6% N.S.; group II: P--96.9%; M--99.3%, P < 0.01 for both; A--66.8%; C--102.7%, P < 0.001; F--42%, P < 0.05). In the non allergic rhinitis group the magnitude of the olfactory loss was more severe except for the odorant musk. Further interpretations as per gender based specificities revealed more severe olfactory loss in males of both the groups for the odorants peppermint and musk and moderately severe olfactory loss for formalin and camphor as compared to females. However, for the odorant asafoetida females showed greater olfactory loss than males in both the groups (delta % 73.38% versus 52% in group I and 81.29% versus 69.7% in group II).

Does nasal breathing cause frictional trauma in allergic rhinitis?

OBJECTIVES: Frictional stress on the walls of a tube increases with increased air flow and as the diameter of the tube is reduced. High values of frictional stress may occur in the nose during nasal obstruction which could damage the nasal mucosa particularly when the mucosa is inflamed and fragile as in allergic rhinitis. The effect of nasal airflow induced frictional stress on the nasal mucosa was studied in patients with allergic rhinitis. METHODS: We studied nasal peak flow rate in eight patients with allergic rhinitis and nasal obstruction comparing the change in peak expiratory flow after they breathed for 30 minutes through an obstructed and a patent nostril. Patients were studied in the right and left lateral decubitus positions to increase and decrease the resistance in the lower and upper nostril respectively and thus minimize any effects of cyclical changes in nasal resistance. Subjects breathed for 30 minutes through the upper patent nostril (schedule 1) and for a further 30 minutes through the lower obstructed nostril (schedule 2). Nasal peak expiratory flow rate was measured in both nostrils separately in both positions after each schedule. RESULTS: There was a significant reduction in mean (SD) nasal peak flow rate (-12.8 (4.06) L/min) after subjects had breathed for 30 minutes through the obstructed nostril. There was no significant change in nasal peak flow rate after subjects had breathed through the patent nostril, or in the nostril that had no flow for 30 minutes. CONCLUSIONS: These findings are compatible with the hypothesis that frictional stress due to airflow through an obstructed nostril induces trauma and swelling of the nasal mucosa of patients with allergic rhinitis.

Quality of life of patients with perennial allergic rhinitis: preliminary validation of the Rhinoconjunctivitis Quality of Life Questionnaire in Singapore.

Though sufferers of perennial allergic rhinitis do not die from their ailment, they endure years of chronic nose disease that Interferes with many important aspects of their lives. A rhinitis-specific instrument to gauge the quality of life of patients with this disease was published in 1991. Here, we validated the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) for use in English-speaking patients with perennial allergic rhinitis. We established that the RQLQ distinguishes between patients and control, demonstrates internal consistency and is sensitive to change. This study suggests that the RQLQ can be used to assess the quality of life of patients with perennial allergic rhinitis in Singapore.

Identificando o respirador bucal / Identifying the mouth ventilator

O cirurgião-dentista é, muitas vezes, o primeiro profissional da Saúde a ter contato com o portador da síndrome da respiração bucal - ou da face longa -, e por isso deve estar atento às suas características, encaminhando o paciente para tratamento multidisciplinar envolvendo ortodontista, fonoaudiólogo e otorrinolaringologista

Environmental controls in reducing house dust mites and nasal symptoms in patients with allergic rhinitis

A randomized comparison group pretest-posttest experimental design was used to quantitatively determine the effects of environmental control measures on patients with allergic rhinitis. Environmental controls included wrapping the mattress with a vinyl cover, washing the top bedding cover with 55 degrees C hot water every two weeks, removal of soft furniture, and wet cleaning of the bedroom floor every day. Thirty subjects were randomly assigned to experimental and control groups. The amount of house dust mites in dust samples collected from the bedroom floor, bedding and mattress, as well as the nasal symptoms of patients, were measured twice at one-month intervals. A significant decrease in house dust mites in dust samples and relief in patients' nasal symptoms were observed in the experimental group who had environmental controls.

Rinitis alérgica / Allergic rhinitis

La rinitis alérgica es el proceso inflamatorio que afecta a la cubierta externa de la nariz, se caracteriza por la presencia de los siguientes síntomas: congestión nasal, rinorrea, estornudos, prurito nasal y/o ocular y en ocasiones descarga retronasal y tos. Afecta tanto a niños como a adultos siendo más frecuente durante la infancia. Es considerada una de las enfermedades alérgicas más frecuentes, se estima su prevalancia en 5-22 por ciento y su incidencia en 10-20 por ciento en población general y de 5-9 por ciento en población pediátrica. Resulta de la interacción entre un alergeno específico (ácaros del polvo, hongos y epitelio de animales), irritantes o contaminantes ambientales y la mucosa nasal, que llevan al desarrollo de una respuesta inflamatoria alérgica temprana y tardía ya sea local o sistémica

Rinitis alérgica y no alérgica / Allergic and non-allergic rhinitis

La rinitis alérgica es una enfermedad crónica muy común que afecta de 10-20 por ciento de la población general. Puede llegar a desaparecer hasta en un 20 por ciento de los casos en edades avanzadas, pero muchos de estos pacientes pueden desarrollar asma. De aquí deriva la importancia de un diagnóstico temprano y manejo adecuado con medidas de control del medio ambiente, uso de antihistamínicos y de inmunoterapia ya que con éstos se puede lograr disminuir el desarrollo de asma hasta en 5 por ciento

Estigmas atópicos en preescolares con rinitis alérgica / Atopic stigmas in chilhood with allergic rhinitis

Se realizó un estudio prospectivo con la finalidad de conocer las características clínicas encontradas más frecuentemente en los pacientes con RA. Se incluyeron a 90 niños con edades de cuatro y cinco años que acudieron al Instituto Nacional de Pediatría, 60 de los cuales tenían diagnóstico de RA y 30 controles libres de enfermedad alérgica. A todos los pacientes con RA se realizaron pruebas cutáneas por el método de punción para demostrar la etiología alérgica y a todos se les determinó IgE total en suero, se realizó exploración física buscando intencionadamente la presencia de stigmas atópicos. Se encontró que la RA se presenta mas frecuentemente en el sexo masculino con una relación de 1.7:1 a esta edad; que un 75 por ciento de los pacientes tenían antecedentes atópicos y que la enfermedad alérgica asociada más frecuentemente es el asma. Las líneas de Dennie Morgan, ojeras alérgicas, conjuntivitis, gesticulaciones, surco nasal, saludo alérgico, xerosis y palidez fueron los estigmas atópicos que se encontraron en mayor porcentaje y con diferencia estadísticamente significativa comparados con el grupo control. Los niveles de IgE se encontraron elevados en 85 por ciento de los pacientes con RA. Se concluye que estos estigmas son dependientes de la presencia de RA

Sensibilización a Blomia tropicalis en pacientes con rinitis y asma en Rosario / Sensitizacion to Blomia tropicalis in patients with rhinitis and asthma in Rosario

El objetivo de este trabajo fue establecer la prevalencia de sensibilidad cutánea a Blomia tropicalis, Dermatophagoides pteronyssinus, Dermatophagoides farinae, Lepidoglyphus destructor, Tyrophagus putrescentiae, Acarus siro y a otros alérgenos en un grupo de pacientes con rinitis y/o asma y de controles en el área del gran Rosario. Se incluyeron un total de 67 pacientes, de los cuales 21 tenían rinitis alérgica, 16 asma, 20 rinitis y asma y 10, síntomas respiratorios no atópicos. También se incluyeron 27 controles sin síntomas alérgicos respiratorios. Se realizaron la determinación de la IgE total y pruebas cutáneas por prick test a B. tropicalis y otros alérgenos en todos los casos. Los niveles de IgE entre los grupos resultaron significativamente diferentes (p<0,05). La frecuencia de sensibilización cutánea a B. tropicalis en el grupo de riníticos fue 61,9 por ciento, en el grupo de asmáticos, 87,5 por ciento, y en el de asmáticos con rinitis, 90 por ciento; ningún paciente con asma y/o rinitis no alérgica y ningún control tuvo una respuesta positiva. La frecuencia de sensibilización simultánea a más de un alergeno fue ò85 por ciento en el grupo de atópicos. Los 6 ácaros evaluados fueron los que presentaron una mayor frecuencia de sensibilización (ò58 por ciento) seguidos por Alternaria con el 8,8 por ciento. Ocho de los 57 pacientes atópicos (14 por ciento) presentaron reactividad cutánea exclusivamente a B. tropicalis. Los resultados obtenidos nos permiten concluir que 1) una alta proporción de pacientes atópicos es sensible a B. tropicalis en la zona del gran Rosario; 2) la prevalencia de dicha sensibilidad es mayor en pacientes con asma y rinitis alérgica; 3) un alto porcentaje de pacientes sensibles a B. tropicalis también lo es a otros ácaros; 4) existe un grupo de pacientes (8/57) tiene sensibilidad exclusiva a B. tropicalis; 5) ningún control sano o sintomático no atópico presentó reacción cutánea a la concentración más alta de B. tropicalis y 6) el extracto de B. tropicalis usado ha demostrado una alta sensibilidad y especificidad