Comparison of buffered and nonbuffered nasal saline irrigations in treating allergic rhinitis.

OBJECTIVES/HYPOTHESIS: We aimed to study the effect of alkalinity of isotonic nasal saline irrigation on nasal symptoms, mucociliary clearance, nasal patency, and patient's preference in patients with allergic rhinitis (AR). STUDY DESIGN: A double-blind, randomized, three-arm crossover study. METHODS: Patients with AR were enrolled. Three kinds of isotonic nasal saline irrigations: nonbuffered (pH 6.2-6.4), buffered with mild alkalinity (pH 7.2-7.4), and buffered with alkalinity (pH 8.2-8.4) were given one at a time, in different orders. Patients rinsed their nose with 240 ml of one solution twice daily for 10 days and then swapped to the others. The washout period was at least 5 days. Primary outcomes were nasal symptoms, mucociliary clearance time, and nasal patency. Outcomes were compared between baseline and posttreatment and also between various kinds of solution. Secondary outcomes were patients' preference and adverse events. RESULTS: Thirty-six subjects entered the study, and there were no dropouts. Overall nasal symptom was significantly improved from baseline (P = 0.03) only by buffered solution with mild alkalinity. Sneezing was significantly improved from baseline (P = 0.04) only by buffered solution with alkalinity. No other significant improvements were achieved by any solution. When comparing between the three nasal irrigations, there were no differences in all parameters. The patients significantly preferred the buffered solution with mild alkalinity (P = 0.02). CONCLUSIONS: Buffered isotonic saline with some degree of alkalinity may improve nasal symptoms. Isotonic saline irrigations, regardless of alkalinity, may not improve mucociliary function and nasal patency. Buffered isotonic saline with mild alkalinity is the most preferred.

Effect of the KTP laser in inferior turbinate surgery on eosinophil influx in allergic rhinitis.

OBJECTIVE: Intranasal corticosteroids (INCS) are first-line medications for moderate to severe allergic rhinitis (AR). Patients who have had nasal congestion for many years often develop inferior turbinate (IT) hypertrophy. Some patients are refractory to INCS yet decline to receive allergen-specific immunotherapy. IT reduction is then indicated. There have been very few studies evaluating the allergic biomarker changes after IT reduction in AR. This study aimed to determine the effect of potassium titanyl-phosphate (KTP) laser IT surgery on eosinophil influx after challenge with dust mites. STUDY DESIGN: A randomized prospective controlled study. SETTING: Tertiary academic rhinology clinic. SUBJECTS AND METHODS: Thirty-five house dust mite AR patients were randomly assigned to receive either INCS or KTP laser IT surgery. On the first visit, 2 nasal lavages prior to and 6 hours after challenge with Dermatophagiodes pteronyssinus were performed before receiving treatment. On the second visit, 3 months after treatment, the same procedures were repeated. No antiallergic medications were allowed for 2 weeks before each visit. Net changes in eosinophil numbers in the lavages were compared at baseline and 3 months after treatment and between the 2 treatments. RESULTS: Treatment with KTP laser IT surgery resulted in a significant reduction in eosinophil influx after nasal challenge (P = .013), whereas such a reduction was not shown in the control. However, the net changes in the percentage of eosinophils were not different between the 2 groups at either visit. CONCLUSION: KTP laser IT surgery reduces eosinophil influx after nasal challenge in perennial AR.

House-dust mite nasal provocation: a diagnostic tool in perennial rhinitis.

BACKGROUND: In perennial allergic rhinitis (PAR), the skin-prick test (SPT) is a good diagnostic tool to identify the specific allergens. A nasal provocation test (NPT) is used to identify allergens and to confirm the diagnosis. The aim of this study was to determine the optimal cutoff values of symptom and peak nasal inspiratory flow (PNIF) changes after dust-mite NPT for predicting PAR. We also studied the relationship of the changes of symptoms in NPT and the wheal size of SPT. METHODS: One hundred five patients with perennial rhinitis underwent the NPT to Dermatophagoides pteronyssinus and the SPT. The NPT was assessed by changes in symptoms and PNIF. The optimal cutoff values of the symptoms score and PNIF changes after the NPT for predicting the SPT were determined using a receiver operating characteristic (ROC) curve. The relationship of the wheal sizes of SPT and the changes from the NPT were analyzed. RESULTS: Forty-eight patients had a positive SPT to D. pteronyssinus, of whom 33 patients had a positive NPT by increases of the symptom score. Twenty patients had a positive NPT by decreases of PNIF. The area under the ROC curve was 0.85 for symptom score changes and it was 0.612 for PNIF changes. There was a significant correlation between the wheal size of the SPT and symptom changes in the NPT. CONCLUSION: Nasal provocation is a valuable test to confirm the diagnosis of D. pteronyssinus allergy, especially when the wheal from the SPT is small. The symptom change after the house-dust mite NPT is better than the PNIF change for predicting the PAR.

House-dust mite nasal provocation: A diagnostic tool in perennial rhinitis.

BACKGROUND: In perennial allergic rhinitis (PAR), the skin-prick test (SPT) is a good diagnostic tool to identify the specific allergens. A nasal provocation test (NPT) is used to identify allergens and to confirm the diagnosis. The aim of this study was to determine the optimal cutoff values of symptom and peak nasal inspiratory flow (PNIF) changes after dust-mite NPT for predicting PAR. We also studied the relationship of the changes of symptoms in NPT and the wheal size of SPT. METHODS: One hundred five patients with perennial rhinitis underwent the NPT to Dermatophagoides pteronyssinus and the SPT. The NPT was assessed by changes in symptoms and PNIF. The optimal cutoff values of the symptoms score and PNIF changes after the NPT for predicting the SPT were determined using a receiver operating characteristic (ROC) curve. The relationship of the wheal sizes of SPT and the changes from the NPT were analyzed. RESULTS: Forty-eight patients had a positive SPT to D. pteronyssinus, of whom 33 patients had a positive NPT by increases of the symptom score. Twenty patients had a positive NPT by decreases of PNIF. The area under the ROC curve was 0.85 for symptom score changes and it was 0.612 for PNIF changes. There was a significant correlation between the wheal size of the SPT and symptom changes in the NPT. CONCLUSION: Nasal provocation is a valuable test to confirm the diagnosis of D. pteronyssinus allergy, especially when the wheal from the SPT is small. The symptom change after the house-dust mite NPT is better than the PNIF change for predicting the PAR.

Expression of mammaglobins A and B in nasal polyps is similar in patients with and without allergic rhinitis.

BACKGROUND: The causes of nasal polyposis remain unclear. Mammaglobins have been implicated in its pathogenesis. However, their association with the occurrence of nasal polyps in the presence of allergic rhinitis (AR) has not been explored. The aim of this study was to compare the expression levels of mammaglobins A and B with the nasal polyps of patients with and without AR. METHODS: Thirty-one patients with bilateral nasal polyposis underwent skin-prick tests to specific aeroallergens. Nasal polyp tissues were obtained from all patients and divided into two groups as nasal polyps with and without AR depending on clinical history and the skin-prick test results. All polyp tissues were analyzed for the levels of mammaglobin A and mammaglobin B by using real-time quantitative polymerase chain reaction technique. RESULTS: Of the 16 samples from patients having nasal polyps with AR, only 1 sample expressed a detectable level of mammaglobin A (1/16). There was no detectable expression of mammaglobin A in tissues from the group of nasal polyps without AR (0/15). Expression of mammaglobin B was detected in all nasal polyp tissues from both groups. The expression of mammaglobin B was not significantly different between nasal polyps with AR (median, 25th-75th percentiles; 0.023, 0.013-0.046) and nasal polyps without AR (0.032, 0.007-0.16). CONCLUSION: Expression levels of mammaglobins A and B in nasal polyps are not different between patients with and without AR. Our findings suggest that mammaglobins' implication in the pathogenesis of nasal polyps is independent of an underlying AR.