The aspects of local allergic rhinitis in Polish children and adolescents.

Introduction: Local allergic rhinitis (LAR) is one of the endotypes of rhinitis which occurs commonly in different age groups. Aim: To present the occurrence and characteristics of LAR in Polish children and adolescents. Material and methods: In the study protocol, three hundred sixty-one patients aged 5-17 with chronic rhinitis were included from 8 centres in Poland. Medical history and diagnostic procedures were performed with aeroallergens: skin prick tests, allergen-specific serum IgE and nasal provocation tests. In addition to LAR, allergic rhinitis (AR), dual allergic rhinitis (DUAL) and non-allergic rhinitis (NAR) were explored and compared. Results: LAR was confirmed in 21% of patients, systemic allergic rhinitis (SAR) in 43.9%, DUAL in 9.4% and NAR in 33.9% of patients. Based on nasal provocation test (NPT), allergy to HDM prevailed in the LAR group (68%), grass in the SAR group (58%), and grass and HDM in the DUAL group (32% and 64%). Girls were prevalent in the LAR group, and severe rhinitis and asthma were more common than other endotypes (p < 0.05). Conclusions: LAR is a common disease in children and adolescents and is often associated with severe rhinitis and frequently coexists with asthma.

The prevalence and characteristics of local allergic rhinitis in Poland.

BACKGROUND: Local allergic rhinitis (LAR) is found in some patients with typical symptoms but who have negative skin prick tests and negative IgE to aeroallergens while presenting with positive nasal provocation tests for proper allergens. Little information about the clinical characteristics and prevalence of LAR has been published. The aim of this study was to determine the prevalence and characteristics of LAR in patients with symptoms of chronic rhinitis. METHODS: In total, 680 patients out of 3400 pre-screened subjects with chronic rhinitis who were at least 5 years old were included from 17 sites in Poland in the study protocol. The following medical history and diagnostic procedures were performed with aeroallergens: skin prick tests, allergen specific serum IgE and nasal provocation tests. In addition to LAR, allergic rhinitis (AR) and non-allergic (NAR) rhinitis were explored and compared. RESULTS: In total, 621 patients were examined. LAR was diagnosed in 109 (17.6%) patients; AR was diagnosed in 251 (40.4%) patients; and NAR was diagnosed in 261 (42%) patients. In the LAR group, younger, non-smoker patients with allergies to D. pteronyssinus or grass pollen were predominant. Polysensitization was more prevalent in AR patients than in LAR patients. Bronchial asthma was at a similar level in patients diagnosed with AR (38%) and LAR (35%) but was significantly less prevalent in patients diagnosed with NAR (16%). The mean age of disease onset was similar between patients with AR and LAR (17.6 plus or minus 4.8 yrs), and it was significantly lower than that in patients with NAR (24.5 plus or minus 6.9 yrs, p less than 0.05). CONCLUSIONS: LAR is a significantly understudied problem in patients of various ages with chronic nasal symptoms. Patients with LAR and AR have similar clinical phenotypes.

Local allergic rhinitis in elderly patients.

BACKGROUND: Local allergic rhinitis (LAR) is characterized by the production of specific IgE in the nasal mucosa and a positive response to a nasal provocation test in the absence of atopy by conventional measurements. There is no information about LAR in elderly people, just as there is little information about allergic rhinitis (AR) in this age group. OBJECTIVE: To investigate the prevalence of LAR, AR, and non-AR in elderly patients with rhinitis. METHODS: In 219 patients with a mean (SD) age of 65.81 (5.88), skin prick tests, serum total specific IgE, and nasal provocation tests against common aeroallergens were performed. In addition, nasal specific IgE was measured in the nasal lavage at baseline and after provocation. For monitoring nasal symptoms, a visual analog scale was used. RESULTS: Of the 219 patients, 46 (21.0%) had LAR, 88 (40.2%) had AR, and 85 (38.8%) were diagnosed as having non-AR. Dermatophagoides pteronyssinus was the main sensitizing aeroallergen in patients with LAR (29 patients [63.0%]) and with AR (48 patients [56.4%]). No significant differences were found between the visual analog scale score and the type of AR (local or nonlocal) and the types of allergens. Clinical responses during the nasal provocation test were associated with significant increases in nasal IgE (Spearman correlation test, R = 0.89, P < .05). Polysensitization was more predominant in patients with AR than in those with LAR (P < .05). CONCLUSION: The results indicate that LAR and AR are common in elderly patients. However, in this age group, these conditions are often underdiagnosed.

[Endoscopic transsphenoidal treatment of pituitary adenomas]. / Endoskopowe leczenie gruczolaków przysadki.

BACKGROUND AND PURPOSE: The aim of this study is to present a new endoscopic transnasal transsphenoidal method of surgical treatment of pituitary adenomas and to evaluate the results and complications of the method. MATERIAL AND SURGICAL TECHNIQUE: From October 2001 to June 2003 in the Department of Neurosurgery of the Medical University of Silesia in Katowice 88 operations of pituitary adenomas were performed using the transnasal transsphenoidal endoscopic method. The group of patients consisted of 50 females and 38 males. The youngest patient was 11 years old and the oldest was 79 years old. Patients were operated on using the 4-mm diameter endoscope with 0- and 30-degree angled lenses, using a method of operation according to Jho and Carrau with own modifications. At the time of surgery the operation team included 2 neurosurgeons, an anesthesiologist and a laryngologist. RESULTS: In the group of 51 nonfunctioning adenomas, in 32 cases we obtained the total removal of the tumor, which amounts to 63%. Among 37 of hyperfunctioning adenomas there were 11 prolactinomas, 19 GH secreting adenomas and 7 ACTH secreting adenomas. In all cases of prolactinomas the tumor was removed totally and in the cases of GH secreting adenomas and ACTH secreting adenomas the total removal of the tumor was performed in 58% and 86% of the cases, respectively. One patient within our group died after the operation. It was the patient with a huge nonfunctioning macroadenoma, with hydrocephalus and preoperative disturbances of consciousness. The permanent diabetes insipidus occurred in 2 cases, which amounts to 2.3% of all operated patients. In this group we noticed the intraoperative CSF leakage in 20 cases but we did not observe the postoperative CSF leakage or any rhinological complications. CONCLUSIONS: The endoscopic transnasal transsphenoidal approach is an efficient method of surgical treatment of pituitary adenomas. The advantage of this method is low invasiveness and a small number of serious complications.