The efficacy of radiofrequency volumetric tissue reduction of hypertrophied inferior turbinate in allergic rhinitis.

Objectives: To evaluate the efficacy of radiofrequency volumetric tissue reduction (RFVTR) technique in treatment of allergic inferior turbinate hypertrophy (ITH) and to study its effect on nasal mucociliary clearance. Materials and Methods: This prospective study was conducted over 50 perenial allergic rhinitis patients with persistent nasal obstruction due to bilateral ITH refractory to medical management received one time RFVTR of both inferior turbinates. Symptoms were subjectively assessed by Visual Analog Scale (VAS) and mucociliary clearance was measured by saccharin transit time (STT) pre-operatively, at 1 week, 1, 3, and 6 months post-operatively. Results: Forty-seven subjects completed study. All patients had significant symptomatic improvement which started from 1 week post-operatively and persisted up to 3 months. Post-operative VAS scores of nasal obstruction, rhinorrhea, sneezing, headache, and snoring at 1 week 1, 3 and 6 month follow up visits significantly decreased (P < 0.05) whereas significant decreased in post-operative VAS scores of hyposmia was observed at 1 month follow up (P < 0.05). Though increase in VAS scores was observed during 6 month follow up, the difference between pre-operative and 6 month post-operative mean VAS score was statistically significant (P < 0.05). Symptomatic improvement in nasal obstruction, rhinorrhea, sneezing, headache, hyposmia, and snoring persisted in 89.4%, 95.6%, 97.8%, 88.5%, 46.7%, and 100% of patients, respectively, during 6 month follow up. There was no significant change in STT following RFVTR except at 1 week follow up (P < 0.0001). Conclusion: RFVTR is safe and effective in treatment of ITH in allergic rhinitis patients.

Thermal reduction of hypertrophied inferior turbinate

Inferior turbinate hypertrophy is one of the commonest causes of nasal obstruction. It can be mucosal or bony hypertrophy. It is seen in patients suffering from vasomotor and allergic rhinitis. To evaluate the effectiveness and complications of diode laser reduction of hypertrophied inferior turbinate in comparison with reduction by submucosal diathermy using electrocoagulation. Forty patients who complained from inferior turbinate hypertrophy were included in our study. Reduction of the hypertrophied turbinate by diode laser and submucosal diathermy was done. The patients were followed up for twelve months. The results from both procedures was analyzed and compared. Sixty percent of our patients were males and forty percent were females. One month after the operation, relief of nasal obstruction was [85%] in laser reduction and [75%] in submucosal diathermy. Six months after the operation the results were [90%] for laser reduction and [85%] for submucosal diathermy, while at the end of the twelve months the results were [85%] for laser reduction and [75%] for submucosal diathermy. One month after the operation no edema or crust could be seen in laser reduction. While in submucosal diathermy oedema were seen one month after the operation and crustation continued till the third month. Laser reduction of inferior turbinate hypertrophy as a long term results is not significantly superior to submucosal diathermy in terms of relief of airway obstruction but it is associated with less complications

Diferencias en la sensibilización a aeroalergenos en pacientes con poliposis nasosinusal / Different patterns of sensitization to airborne allergens in patients with nasal polyposis

Introducción: La poliposis nasosinusal (PN) es una enfermedad inflamatoria crónica de la mucosa. Apoyado en los hallazgos clínicos, histológicos e inmunológicos, se postula a la alergia como un factor etiopatogénico, lo cual no ha sido plenamente demostrado. Objetivo: Evaluar la presencia de hipersensibilidad a aeroalergenos en pacientes con PN y compararla con pacientes normales. Material y método: Se realizó prick test a aeroalergenos a todos los pacientes utilizando 30 alérgenos frecuentes en el área metropolitana de Santiago, incluyendo pólenes de árboles, malezas y pastos, ácaros, epitelio de animales y hongos habituales. Este test se amplió con el uso de tres hongos habitualmente no evaluados (Stemphyllium, Pullularia, Helminthosporium). Se utilizó la prueba de Chi cuadrado con una significancia de 0,05. Resultados: El 71 por ciento de los pacientes con PN (n =73) y el 66 por ciento del grupo control (n =44) presentaban un test cutáneo positivo, sin diferencia estadística significativa. El patrón de sensibilización a aeroalergenos fue similar, salvo para los alérgenos fúngicos: los pacientes con PN estaban sensibilizados en 40 por ciento a Pullularia, 30 por ciento a Stemphyllium, y 10 por ciento a Helminthosporium. En tanto que los controles no presentaron sensibilización a estos hongos no habituales. Discusión y conclusiones: Existe una alta tasa de sensibilización a aeroalergenos en pacientes normales y con PN, lo que sugiere un probable rol de la alergia en la patogénesis de la poliposis nasal. Destaca un patrón diferente de sensibilización a alérgenos fúngicos, cuya relevancia clínica debe ser evaluada a futuro.

Introduction: Nasal polyposis (NP) is a chronic inflammatory disease that leads to tissue oedema and eventually polyps. The pathogenesis of NP has not been fully understood yet, but there are clinical, histological, and immunological findings that suggest that allergy plays a role. Aim: The aim of this study was to find out the prevalence of airborne allergen hypersensitivity in patients with nasal polyposis. Material and method: Skin prick test (SPT) was performed to patients with NP and to a control group (CRS). Thirty frequent airborne allergens of the Santiago de Chile metropolitan area, including tree, grass and weed pollens, house dust mites, animal dander and common fungal allergens were tested. This SPT was extended by using three fungal allergens that usually are not evaluated (Stemphyllium, Pullularia, Helminthosporium). Chi square test was used to compare both groups of patients. Results: 71 percent of NP patients (n=73) versus 66 percent of the controls (n=44) had a positive SPT, although there was no statistical significance. The only difference in sensitization was for fungal allergens. In NP patients, sensitization to Pullularia was about 40 percent>, 30 percent> to Stemphyllium, and 10 percent to Helminthosporium. CRS patients were not sensitized to uncommon fungal allergens. Conclusions: We found a high frequency of sensitization to airborne allergen in CRS and NP patients that suggest a probable role of allergic inflammation in the pathogenesis of nasal polyposis. Stands out a different pattern of sensitization to fungal allergens in the NP group; the clinical relevance of this finding awaits future evaluation.

Prevalência de asma e rinite alérgica em escolares no município de Santo Ângelo/RS / Prevalence of asthma and allergic rhinitis among students from Santo Ângelo/RS

Introdução: A asma é uma doença inflamatória crônica, caracterizada por hiper-responsividade das vias aéreas inferiores que se manifesta por episódios recorrentes de sibilância, dispnéia, aperto no peito e tosse. Objetivo: Determinar a prevalência de asma e rinite alérgica em adolescentes do município de Santo Ângelo/RS. Metodologia: Foi realizado um estudo observacional, prospectivo e transversal; a amostra foi constituída por estudantes de 13 a 14 anos. Foram investigadas as variáveis: sexo, idade e interferência dos sintomas das doenças nas atividades diárias através da aplicação de um questionário epidemiológico padronizado do ISAAC (International Study of Asthma and Allergies in Childhood). Resultados: O número de questionários aplicados foi de 1.031, sendo considerados válidos 979 (94,9 por cento). A prevalência de asma nos adolescentes foi de 10,5 por cento, baseada na questão “já teve ou tem asma”. A prevalência de rinite alérgica foi de 34,6 por cento, baseada na questão “já teve ou tem rinite alérgica”. Quanto à polinose “alergia ao pólen na primavera” a prevalência foi de 30,4 por cento. Considerando-se o sub-diagnóstico das doenças, a prevalência de prováveis asmáticos foi de 12 por cento e a de adolescentes com provável rinite de 12 por cento. Conclusão: A prevalência de asma no presente estudo mostrou-se entre os valores médios mundiais e nacionais, já as prevalências de rinite alérgica e polinose mostraram-se elevadas de acordo com as médias de outros estudos. Estes dados apontam que em Santo Ângelo/RS essas doenças constituem um problema de saúde pública entre os adolescentes.

Introduction: Asthma is an inflammatory chronic disease, characterized as a hyperresponsivity of the lower airways that manifests itself through recurrent episodes of sibilance, dyspnea, chest pressure, and coughing. Aim: To determine the prevalence of asthma and allergic rhinitis in adolescents living in the municipality of Santo Ângelo/RS. Methods: An observational transversal, prospective study was performed, the sample comprising 13- and 14-year-old students. The variables sex, age, and interference of the symptoms of the disease in the daily activities were investigated through the administration of the standardized epidemiological questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC). Results: Of the 1,031 questionnaires responded, 979 (94.9 percent) were considered as valid. The prevalence of asthma among the adolescents was 10.5 percent, based on the question: “Have you ever had asthma?”. The prevalence of allergic rhinitis was 34.6 percent, based on the question “Have you ever had allergic rhinitis?. As for pollen allergy during the spring, the prevalence was 30.4 percent. Considering the underdiagnosis of the diseases, the prevalence of probable asthmatics was 12 percent and of adolescents with probable rhinitis was 12 percent. Conclusion: The prevalence of asthma in the present study was consistent with the reported mean world and national values, but the prevalences of allergic rhinitis and pollen allergies were high as compared to the means reported elsewhere. The data indicate that in Santo Ângelo, RS these conditions are a public health problem among adolescents.

Depressive symptoms in patients with allergic rhinitis, correlation to severity and response to treatment

Symptomatic allergic rhinitis has been associated with variable degrees of depressive symptoms, the degree of which is directly related to the severity of symptoms and the response to treatment. In this study we aimed to assess the depressive symptom score in allergic rhinitis patients and its affection by response to treatment. In this study we aimed to compare the results between the male and female populations. The study included 60 patients in 2 groups, one received full treatment course for allergy, and the second received only a placebo. We used the SNOT for assessment of nasal symptoms, and the Beck Scale for assessment of the depressive symptoms. The over all results showed that a degree of depression is present in most patients with allergic rhinitis, the severity of which is directly related to the severity of allergic symptoms, and improves with the reduction of allergic symptoms. Lack of improvement or poor response to treatment exacerbates the depressive status. with a more severe affection and increased liability in female population than in the male one

Factores asociados con la presencia de hiperreactividad bronquial en rinitis alérgica de niños y adolescentes / Factors associated with presence the bronchial hyperresponsiveness in allergic rhinitis the children and adolescent

Objetivos: la hiperreactividad bronquial (HRB) inespecífica está presente en el asma bronquial así como en otras enfermedades respiratorias y no respiratorias. Fue nuestro objetivo investigar la prevalencia de HRB inespecífica a la metacolina y los factores asociados con su presencia en un grupo de niños y adolescentes con rinitis alérgica (RA). Material y métodos: se incluyeron 25 niños y adolescentes de ambos sexos, entre 7 y 19años de edad, con diagnóstico de rinitis alérgica, sin asma bronquial previo o actual. Los pacientes fueron clasificados en dos grupos: metacolina positivos (MTC +) y metacolina negativos (MTC Ä) según reactividad bronquial manifiesta a la prueba de broncoprovocación con metacolina (umbral diferencial PC20FEV1=16 mg/ml). Se estudiaron comparativamente los niveles hemáticos de IgE y eosinófilos, IgA secretoria, eosinófilos en secreción nasal, presencia de anormalidades en la radiografía de senos paranasales y, por interrogatorio, el tiempo de evolución de RA, condición de fumador pasivo y antecedentes hereditarios de asma bronquial. Resultados: la prevalencia de HRB a la metacolina fue del 56 por ciento: 14 de 25 pacientes tuvieron un PC-20FEV1ó16 mg/ml...

Standardization of methacholine inhalation challenge by a reservoir method.

Standardization of methacholine inhalation challenge (MIC) by a reservoir method was performed at Respiratory Unit, Chulalongkorn Hospital. One hundred subjects, including 20 non-smoking healthy subjects, 20 patients with isolated chronic cough, 20 patients with isolated allergic rhinitis, 20 patients with stable chronic obstructive bronchitis, and 20 patients with mild bronchial asthma, were scheduled to perform the test. The aerosolized methacholine was produced by an atomized nebulizer of the Provocation test I (Pari-Starnberg) and the aerosol was kept in a reservoir bag. It was inhaled by each subject via a slow vital capacity. Increasing concentrations of methacholine (0, 0.5, 1, 5, 10, and 25 mg/ml were used. None of the healthy subjects had increased bronchial hyperresponsiveness (BHR). Sixty percent of patients with chronic cough, 60% of patients with allergic rhinitis, 95% of patients with chronic obstructive bronchitis, and 100% of patients with asthma were found to be positive in the MIC tests. No serious effect from methacholine during and after the tests was found. It was concluded that MIC can be easily performed by a reservoir with reproducible results to demonstrate BHR.

Epidemiologia da polinose na populaçäo de algumas cidades do Estado do Rio Grande do Sul / Epidemiology of pollinosis in the population of some cities from the state of Rio Grande do Sul

A incidência de sensibilizaçäo a pólens tem aumentado recentemente na Regiäo Sul do Brasil. Através de entrevistas dirigidas, foi estudada uma populaçäo de 4.207 indivíduos em diferentes cidades do Estado do Rio Grande do Sul. A periodicidade anual da doença, associada aos sintomas característicos, permitiu diagnosticar neste grupo 62 (1,4%) pessoas com provável polinose. A cidade de Caxias do Sul, com uma incidência de 4,8%, somada a pesquisas paralelas nas áreas médica e botânica, constitui regiäo de polinose endêmica, asim como a cidade de Passo Fundo, que apresenta uma incidência média de 2,3%

Progressive Development of Bronchial Asthma from Allergic Rhinitis in a Patient Sensitized to Artemisia SPP. Pollen: A Case Report

The association between allergic rhinitis and bronchial asthma, that is, whether it is a seqential process or independent diseases, has not been established. We confirmed that a 25 year-old woman with allergic rhinitis sensitized to Artemisia spp. pollens and house dust mites developed bronchial asthma during a 2 year follow-up period. Severe broncho-constriction was noted after inhalation of methacholine, and the bronchoprovocation test with extract of Korean Artemisia spp. pollen showed early bronchoconstiction. Total IgE and specific IgE antibodies to Artemisia absinthium increased, compared to the initial levels. It is suggested that some patients with allergic rhinitis progress to bronchial ashtma.