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Chronic Nonallergic Rhinitis

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141. Provocative factors in asthma

for viral provocation of allergy and asthma. This is consistent with a study of experimental HRV infection in asthmatic adults, which resulted in augmented eosinophilic inflammation (assessed in sputum) and enhanced bronchial responsiveness. In another controlled study of experimental HRV infection in people with allergic rhinitis (but no asthma) and a nonallergic control group, there was a significant increase in bronchial responsiveness to histamine in the allergic group. Rhinovirus infection (...) risk factor for symptomatic asthma. Nevertheless, the importance of the environment is dependent on the predominant exposures in that environment, which are influenced by cultural and geographic factors. Seasonal changes in indoor allergen levels have been associated with changes in bronchial responsiveness. In 32 people with asthma, who were allergic to dust mites, the provocative concentration of histamine giving a 20% fall in FEV 1 (PC 20 ) increased from 2.05 mg/mL in autumn to 4.51 mg/mL

1999 CPG Infobase

142. Diagnosis and evaluation of asthma in adults

may be an adjunct to diagnosis and is discussed in this section. Symptoms Common symptoms of asthma include wheezing, chest tightness, dyspnea and cough. The characteristics of these symptoms, which are variable, often paroxysmal and provoked by allergic or nonallergic stimuli such as cold air and irritants, are useful in diagnosis. Nocturnal occurrence is common. Measuring the patient's response to a therapeutic trial may be helpful in diagnosis. Nonpulmonary symptoms that suggest (...) a predisposition to allergy - rhinitis, conjunctivitis and eczema - are also common in, but not specific to, asthma patients. In patients with symptoms that are persistent or that do not respond to simple treatment, objective confirmation of variable airflow obstruction is required. Variable airflow obstruction Objective measurements are needed to confirm the diagnosis of asthma in all patients and to assess its severity. Objective documentation of variable airflow obstruction can be obtained through

1999 CPG Infobase

143. In a 45 yr old man with post nasal drip, what is the most effective treatment to reduce symptoms? What alternatives are there?

the TRIP, Cochrane and Medline databases as well as the NLH Specialist Library for ENT but found no overview of interventions for post nasal drip. However, we did locate information on individual treatments. The Agency for Healthcare Research and Quality (AHRQ) evidence-based technology assessment on the management of allergic and non-allergic rhinitis reported: “Studies provide strong support for the beneficial effect of cromoglycate in the management of both seasonal and perennial allergic rhinitis (...) for controlling the spectrum of allergic rhinitis symptoms and should be considered as first line therapy in patients with moderate to severe symptoms.” [2] Grzincich writing in an abstract to an article on the effectiveness of intranasal corticosteroids notes: “Intranasal corticosteroids (IC) are most commonly prescribed to treat allergic rhinitis (perennial and seasonal). There are now many IC available to treat rhinitis, all effective on nasal obstruction, rhinorrhea, sneezing, itching and post-nasal drip

2006 TRIP Answers

144. A patient suspects he is allergic to aspirin and ibuprofen, his 'symptoms' appear mild (cold-like). What are the main features of aspirin allergy and how common is a shared allergy to both aspirin an

in atopic individuals (persons with a hereditary predisposition toward developing certain hypersensitivity reactions such as hay fever, asthma, or urticaria). Additionally, NSAIDs exacerbate urticaria in one third to two thirds of patients with chronic idiopathic urticaria.” We found little to offer by way of evidence about patients who are sensitive to both aspirin and ibuprofen, although eBNF says of NSAIDS (4): “they are contra-indicated in patients with a history of hypersensitivity to aspirin (...) -specified methods, the reported sensitivity rates to aspirin were lowest (0.3% to 0.9%) for patients without allergic tendencies, higher in asthmatics, and highest if patients had nasal polyps or severe atopy. Although not determined in any of these studies, the rate of sensitivity in a general (nonclinical) population would doubtlessly be substantially lower than the rate of three per 1000 reported for nonallergic patients. The admixture of different clinical groups, varying definitions

2006 TRIP Answers

145. Differential Gene Expression in Lung and Peripheral Blood After Inhaled Allergen Challenge

and normal phenotypes. This approach is designed to identify novel genes associated with both asthma pathogenesis (differentially expressed in the exposure-response study) and asthma susceptibility (genetically associated with asthma in a linkage/association study). Patients with asthma and allergic rhinitis have long been known to have positive skin test responses to house dust. In the 1960's it was shown that the dust mite was the most important source of allergen in house dust. Techniques for growing (...) dust mites in the laboratory enabled the preparation of dust mite allergen extracts. Identification of the major allergens of dust mite along with specific skin test methodology has resulted in standardized dust mite allergen extracts for diagnostic and therapeutic use. Numerous epidemiologic studies have demonstrated the importance of sensitization to dust mite as risk factors for asthma and allergic rhinitis symptoms. Administration of dust mite by inhalation is considered investigational

2008 Clinical Trials

146. Mast cell quantitation in non- neoplastic polypoidal nasal lesions Full Text available with Trip Pro

polyps", 8 (44.5%) showed more than 20,000 mast cells/ mm(3) in the subepithelial layer, and, 8 (44.5%) more than 20,000 mast cells/mm(3) in the deeper areas. Interestingly, mast cells were also seen in very high numbers in 33-38% of cases of chronic hypertrophic rhinitis, rhinosporidiosis and mucormycosis. There was no correlation between the proportion of eosinophils and mast cells in the lesions. We conclude that mast cells are not restricted to allergic nasal lesions and the significance (...) Mast cell quantitation in non- neoplastic polypoidal nasal lesions The distribution and abundance of mast cells was studied in 110 nasal non- neoplastic polypoidal lesions. In most of the polyps of all kinds, the epithelium showed less than 5000 mast cells/mm(1). Out of the 72 so- called "nonallergic polyps", 29 (40,3%) showed more than 20,000 mast cells/mm(1) in the subepithelial layer, and 30 (41.7%) more than 20,000 mast cells/mm(1) in the deeper areas. Out of the 18 so- called "allergic

2004 Indian Journal of Otolaryngology and Head & Neck Surgery

147. NARES: a risk factor for obstructive sleep apnea? (Abstract)

NARES: a risk factor for obstructive sleep apnea? Nonallergic rhinitis with eosinophilia syndrome (NARES) constitutes a rare nasal condition characterized by a chronic, eosinophilic inflammation. Patients' major complaints constitute nasal congestion and rhinorrhea. Obstructive sleep apnea syndrome (OSAS) is a potentially life-threatening condition characterized by recurrent episodes of obstruction of the upper airways resulting in oxygen desaturation. Nasal congestion constitutes one (...) predisposing factor for OSAS.The purpose was to study whether NARES constitutes a risk factor for OSAS.The study included 26 patients presenting typical symptoms of sleep apnea. Ten patients were diagnosed to suffer from NARES (mean age 56.8 +/- 12.5, body mass index [BMI] 29.3 kg/m(2) +/- 2.8; 9 men:1 woman) and were compared with 16 age- and BMI-matched individuals (mean age 58.8 +/- 11.6, BMI 29.7 kg/m(2) +/- 3.8, 16 men) without any nasal inflammation, such as allergic rhinitis, sinusitis, nasal

2004 American Journal of Otolaryngology

148. Efficacy of montelukast in the treatment of nasal polyposis. (Abstract)

Efficacy of montelukast in the treatment of nasal polyposis. Twenty-four consecutive patients with symptomatic nasal polyposis and nonallergic or perennial rhinitis who were undergoing chronic nasal steroid therapy were prospectively evaluated for response to adjunctive oral montelukast sodium therapy.The patients were undergoing daily intranasal steroid sprays for a minimum of 6 months before being started on montelukast sodium 10 mg by mouth per day for 3 months while intranasal steroids were (...) by potential seasonal allergic responses.The patients tended to improve on montelukast therapy in terms of their symptom scores and polyp eosinophil counts. The symptoms improved in 17 patients (71%) and remained the same or worsened in 7 patients (29%). The symptom score for the group improved from a pretreatment value of 33.4 (SD, 7.73) to a posttreatment value of 23.3 (SD, 13.73; p < .001). In addition, the eosinophilia score improved from 2.3 (SD, 0.68) to 1.5 (SD, 0.82; p < .01). The improvement

2005 Rhinology and Laryngology

149. Low prevalence of the intrinsic form of atopic dermatitis among adult patients. (Abstract)

Low prevalence of the intrinsic form of atopic dermatitis among adult patients. Atopic dermatitis (AD) is a chronic inflammatory skin disease commonly associated with respiratory allergies such as rhinitis and asthma, and a high serum level of IgE. In contrast to the 'classic' IgE-mediated allergic (extrinsic) form of AD, approximately 20% of the patients are reported to show normal IgE levels, lack of sensitizations towards environmental allergens, and absence of associated respiratory (...) allergies. Accordingly, these patients are assigned to a nonallergic (intrinsic) form of the disease.In order to define these two forms of AD more closely, 259 adult patients with AD were investigated.After a thorough diagnostic workup there were 18 patients (6.9%), who fulfilled the criteria of intrinsic AD. After follow-up, four additional patients had developed respiratory allergies or IgE-mediated sensitizations resulting in an overall proportion for intrinsic AD of 5.4%.Based on these figures

2006 Allergy

150. Neuropathology in rhinosinusitis. (Abstract)

Neuropathology in rhinosinusitis. Pathophysiologic differences in neural responses to hypertonic saline (HTS) were investigated in subjects with acute sinusitis (n = 25), subjects with chronic fatigue syndrome (CFS) with nonallergic rhinitis (n = 14), subjects with active allergic rhinitis (AR; n = 17), and normal (n = 20) subjects. Increasing strengths of HTS were sprayed into their nostrils at 5-minute intervals. Sensations of nasal pain, blockage, and drip increased with concentration

2005 American Journal of Respiratory and Critical Care Medicine

151. Intranasal beclomethasone dipropionate in the treatment of common cold. (Abstract)

Intranasal beclomethasone dipropionate in the treatment of common cold. Sinusitis is usually considered a complication of viral rhinitis. Virus infections in the upper respiratory tract lead to mucosal swelling, which may obstruct paranasal sinus outflow, resulting in infection in the paranasal sinuses. Topical nasal steroids have been found beneficial in a variety of acute and chronic nasal conditions including allergic and nonallergic rhinitis and chronic rhinosinusitis. The purpose (...) of intranasal BDP in the treatment of common cold neither reduced symptoms caused by inflammation nor did it shorten the recovery time. On the other hand, because BDP does not increase the risk of complications or significantly prolong the recovery during the common cold, there is no need to discontinue its use in the patients with allergic rhinitis or nasal polyposis.

2001 Rhinology Controlled trial quality: uncertain

152. perennial rhinitis

perennial rhinitis perennial rhinitis - General Practice Notebook This site is intended for healthcare professionals General Practice Notebook | Medical search perennial rhinitis Allergic rhinitis may be: seasonal (also called "hay fever") caused by grass, tree pollen allergens, symptoms can seen during the same time each year perennial caused by house dust mites, symptoms occur right throughout the year occupational caused by allergens at workplace e.g.- flour allergy in a baker(1) Allergic (...) rhinitis can also be divided according to the severity and persistence of symptoms: mild intermittent moderate severe intermittent mild persistent moderate severe persistent (1) It is characterized by rhinorrhoea nasal blockage sneezing attacks for longer than 1 hour per day lasting longer than 2 weeks itching - eyes, nose watery eyes fatigue malaise headache (2) wheezing shortness of breath (3) Allergic rhinitis may coexist with asthma, eczema, or chronic sinusitis. It occurs when an individual

2010 GP Notebook

153. hay fever

hay fever hay fever - General Practice Notebook This site is intended for healthcare professionals General Practice Notebook | Medical search hay fever Allergic rhinitis may be: seasonal (also called "hay fever") caused by grass, tree pollen allergens, symptoms can seen during the same time each year perennial caused by house dust mites, symptoms occur right throughout the year occupational caused by allergens at workplace e.g.- flour allergy in a baker(1) Allergic rhinitis can also be divided (...) according to the severity and persistence of symptoms: mild intermittent moderate severe intermittent mild persistent moderate severe persistent (1) It is characterized by rhinorrhoea nasal blockage sneezing attacks for longer than 1 hour per day lasting longer than 2 weeks itching - eyes, nose watery eyes fatigue malaise headache (2) wheezing shortness of breath (3) Allergic rhinitis may coexist with asthma, eczema, or chronic sinusitis. It occurs when an individual, previously exposed to an antigen

2010 GP Notebook

154. Sinusitis and chronic progressive exercise-induced cough and dyspnea. (Abstract)

Sinusitis and chronic progressive exercise-induced cough and dyspnea. We present the case of a 47-year-old man with exercise-induced dyspnea, cough, chest tightness, and recalcitrant chronic rhinosinusitis. Evaluation revealed IgE sensitization to grass, tree, and weed pollen, no evidence of obstruction on spirometry, and a negative methacholine challenge. Diagnostic considerations included allergic and nonallergic rhinitis, asthma, aspirin-exacerbated respiratory disease, vocal cord

2008 Allergy and Asthma Proceedings

155. Conditions that masquerade as chronic rhinosinusitis: a medical record review. Full Text available with Trip Pro

diagnoses were collected and analyzed using descriptive statistics.Of 186 patients, 112 (60%) had CRS and 74 (40%) did not. The most common diagnoses among the patients who did not have CRS were allergic rhinitis (n = 37), laryngitis associated with reflux (n = 21), head or facial pain (n = 18), and nonallergic rhinitis (n = 23). Many patients had more than 1 diagnosis.Among a tertiary care population, common medical disorders, including rhinitis, laryngitis associated with reflux, and headache (...) Conditions that masquerade as chronic rhinosinusitis: a medical record review. To identify conditions that are commonly mistaken for chronic rhinosinusitis (CRS). The hypothesis was that many patients referred to a rhinology clinic with a presumptive diagnosis of CRS do not have CRS.Retrospective, observational design study of adult patients referred for evaluation of CRS-like symptoms. The expert opinion of the rhinologist was the diagnostic standard.Tertiary care rhinology clinic.A

2006 Archives of Otolaryngology Head and Neck Surgery

156. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Full Text available with Trip Pro

cause of chronic cough. The symptoms and signs of PNDS are nonspecific, and a definitive diagnosis of PND-induced cough cannot be made from the medical history and physical examination findings alone. Furthermore, the absence of any of the usual clinical findings does not rule out a response to treatment that is usually effective for PND-induced cough. The differential diagnosis of PNDS-induced cough includes allergic rhinitis, perennial nonallergic rhinitis, postinfectious rhinitis, bacterial (...) "cough," "causes of cough," "etiology of cough," "postnasal drip," "allergic rhinitis," "vasomotor rhinitis," and "chronic sinusitis." Case series and prospective descriptive clinical trials were selected for review. Also, any references from these studies that were pertinent to the topic were obtained.In multiple prospective, descriptive studies of adults, PNDS due to a variety of upper respiratory conditions has been shown either singly or in combination with other conditions, to be the most common

2006 Chest

157. Prevalence of nasal symptoms and their relation to self-reported asthma and chronic bronchitis/emphysema. (Abstract)

allergic and/or nonallergic nasal symptoms. Nasal symptoms were frequently found to coexist with both asthma and chronic bronchitis/emphysema, suggesting that pan-airway engagement is common in both diseases. Differing associations between types of nasal symptoms and allergic and irritant triggers of nasal symptoms, with regard to asthma and chronic bronchitis/emphysema, emphasize the different natures of these bronchial diseases. (...) Prevalence of nasal symptoms and their relation to self-reported asthma and chronic bronchitis/emphysema. Little information is available on associations between rhinitis and chronic bronchitis/emphysema (CBE). Self-reported upper airway symptoms, asthma, and CBE were examined in 12,079 adults living in southern Sweden. The response rate was 70% (n=8,469), of whom 33% reported significant nasal symptoms: a blocked nose was reported by 21%; sneezing by 18%; nasal discharge by 17%; and thick

2001 The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology Controlled trial quality: uncertain

158. The burden of rhinitis in a managed care organization. (Abstract)

The burden of rhinitis in a managed care organization. Rhinitis is a common health condition, but the extent of the burden in managed care organizations (MCOs) has not been well described.To compare medical utilization in a large MCO of patients (1) with vs without rhinitis and (2) with allergic (AR) vs nonallergic (NAR) rhinitis.Patients 4 years and older with 1 or more encounters with an International Classification of Diseases, Ninth Revision, code for rhinitis and patients treated (...) (OR, 4.4), chronic sinusitis (OR, 15.2), conjunctivitis (OR, 1.5), acute otitis media (OR, 1.9), chronic otitis media (OR, 4.3), sleep apnea (OR, 3.4), and fatigue (OR, 2.0). Results for rhinitis treatment-only patients (n = 242,565) were generally similar to those for rhinitis encounter patients. NAR was diagnosed in 21% of patients, who were significantly more likely than patients with AR to undergo sinus radiology and nasal surgery; to receive diagnoses of sinusitis, otitis media, sleep apnea

2008 Asthma & Immunology

159. The role of the nervous system in rhinitis. (Abstract)

apparatuses. Reflexes directed to the nose are also generated by inputs from other body regions. Hence all symptoms that constitute the nosologic entity of rhinitis can be triggered through neural pathways. In addition, neural signals generated in the nose can influence distal physiology, such as that of the bronchial tree and the cardiovascular system. Neural function can be chronically upregulated in the presence of mucosal inflammation, acutely with an allergic reaction, or even in the absence (...) of inflammation, as in cases of nonallergic rhinitis. Upregulation of the nasal nervous system can occur at various levels of the reflex pathways, resulting in exaggerated responses (neural hyperresponsiveness), as well as in increased capacity for generation of neurogenic inflammation, a phenomenon that depends on the release of neuropeptides on antidromic stimulation of nociceptive sensory nerves. The molecular mechanisms of hyperresponsiveness are not understood, but several inflammatory products appear

2006 Journal of Allergy and Clinical Immunology

160. Idiopathic rhinitis, the ongoing quest. (Abstract)

Idiopathic rhinitis, the ongoing quest. The term rhinitis in daily practice is used for nasal dysfunction causing symptoms-like nasal itching, sneezing, rhinorrhea and or nasal blockage. Chronic rhinitis can roughly be classified into allergic, infectious or nonallergic/noninfectious. When allergy, mechanical obstruction and infections have been excluded as the cause of rhinitis, a number of poorly defined nasal conditions of partly unknown aetiology and pathophysiology remain. The differential (...) diagnosis of nonallergic noninfectious rhinitis is extensive. Although the percentage of patients with nonallergic noninfectious rhinitis with a known cause has increased the last decades, still about 50% of the patients with nonallergic noninfectious rhinitis has to be classified as suffering from idiopathic rhinitis (IR), or rather e causa ignota. Specific immunological, clinical and sometimes radiological and functional tests are required to distinguish known causes. Research to the underlying

2005 Allergy

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