RESUMO
BACKGROUND: Allergic rhinitis (AR) is a common respiratory disease encompassing a variety of phenotypes. Patients can be sensitized to 1 or more allergens. There are indications that polysensitization is associated with more severe disease. However, the extent to which the level of sensitization is associated with clinical disease variability, underlying the distinct nature of AR from AR+ conjunctivitis or AR+ asthma, is not known. OBJECTIVE: To evaluate phenotypical differences between monosensitized and polysensitized patients with AR and to quantify their symptomatic variability. METHODS: A total of 565 patients with a confirmed diagnosis of AR were included in this cross-sectional study. Of those, 155 were monosensitized and 410 were polysensitized. Interactions between sensitization levels and the reporting of different symptoms of AR and co-morbidities, disease duration, and impact were assessed. Furthermore, patients were stratified into monosensitized, oligosensitized, and polysensitized to assess whether the effect of sensitization on the phenotype was ranked. RESULTS: Polysensitized patients reported itchy eyes significantly more often (P = .001) and had a higher number of ocular (P = .005), itch-related (P = .036), and total symptoms (P = .007) than monosensitized patients. In addition, polysensitized adults and children more often reported wheeze (P = .015) and throat-clearing (P = .04), respectively. Polysensitization was associated with more burdensome AR based on a visual analog scale (P = .005). Increased sensitization level was reflected in more itchy eyes, a higher number of ocular, itch-related, and total number of symptoms, and disease burden. CONCLUSION: With an increasing number of sensitizations, patients with AR experience an increased diversity of symptoms. Multimorbidity-related symptoms increase with sensitization rank, suggesting organ-specific thresholds.
RESUMO
PURPOSE: Obstruction of the nasolacrimal duct is a serious chronic condition, treatment for which has not yet been successfully resolved. Several methods have been proposed for the management of chronic epiphora. A modified method of intranasal laser-assisted dacryocystorhinostomy with the use of a surgical microscope is described. MATERIALS AND METHODS: The procedure is a modification to the West and Veis-Claus-Guttich method. The primary and late results of this method are presented for 53 patients over the past 7 years with chronic epiphora caused by stenosis of the nasolacrimal duct. Selection criteria included chronic epiphora, nasolacrimal duct stenosis due to Down syndrome, empyema of the lacrimal sac, and recurrence from previous operations. Patients were operated on under general anesthesia. RESULTS: Fifty-one patients (96.3%) were free of symptoms postoperatively (mean follow-up time, 6 months). CONCLUSION: The simplicity of this method compared with traditional methods is correlated with excellent postoperative results and patient satisfaction.
