A Prospective Cross-Sectional Study on Exhaled Nitric Oxide and Sensitivity to Indoor Inhaled Aeroallergens in Patients with Rhinosinusitis with Nasal Polyps

Background: Rhinosinusitis is a nasal and paranasal sinus infection. Chronic infection and allergies are two major causes of nasal polyp formation. Objectives: In this study, we examined the relationship between NO and aeroallergens to determine the relationship between exhaled nitric oxide level and sensitivity to aeroallergens in chronic rhinosinusitis with nasal polyps (CRSwNP) patients referring to Hazrat Rasool Hospital in Tehran from December 2016 to May 2017. Methods: A cross-sectional study was conducted on 72 patients. The prick test and exhaled NO measurements were done to determine allergens in CRSwNP patients. Statistical analysis was done to determine the relationship between the allergy and sensitivity to indoor aeroallergens in patients with CRSwNP. Results: The correlation coefficient of. 0.014 and 0.001 were evaluated for Mosquito and Cockroach respectfully, which were significantly correlated with nitric oxide. The less correlation with nitric oxide was 0.003, which was evaluated for MUCOR. Conclusions: This study showed that most people with CRSwNP had a sensitivity to at least one indoor aeroallergen, and cockroaches were the most common allergen in patients with CRSwNP with a 17.9% prevalence. This study showed that the correlation of FeNO with the sensitivity of these patients to home aeroallergens can be used, and this correlation for mosquito and cockroach aeroallergens is very valuable. The NO level and prick testing of aeroallergens can be used to estimate the relapse or lack of appropriate response to medical treatment in patients with CRSwNP.

Experience Of Ocular Symptoms Among Allergic Rhinitis Patients Depending On The Type Of Aeroallergens

The aim of this study was to determine the frequency of ocular symptoms and compare the demographic and clinical characteristics in AR patients depending on sensitisation to various types of aeroallergens. Allergic rhinitis is defined as an IgE-mediated inflammation of the lining of the nose that is characterized by nasal symptoms, including nasal congestion, sneezing, itching of nose and runny nose. Patients suffering from allergic rhinitis frequently experience ocular symptoms such as ocular redness, eye itching and tears. The frequency of ocular symptoms in our study population was 27,6%. No statistical significance was found in the mean ages of the patients who did or did not experience ocular symptoms p>0,05 (p=0,243). Our results indicated that there were no statistical differences (p>0,05) among the groups of allergic rhinitis patients based on experiencing nasal symptoms according to the types of aeroallergens. Our results indicated that there were significant experiences of ocular symptoms in patients who were sensitised to outdoor aeroallergens (p<0,001) and significant sensitisation to both outdoor and indoor aeroallergens (p<0,05). Experiencing the examined ocular symptoms, including ocular redness, eye itching and tears, demonstrated highly statistical significance (p<0,001) among the groups of allergic rhinitis patients who were sensitised to indoor aeroallergens and outdoor aeroallergens, and there was statistical significance (p<0,05) among the groups of allergic rhinitis patients who were sensitised to indoor aeroallergens and both types of aeroallergens (indoor and outdoor). Ocular symptoms are more common in patients who are sensitised to outdoor aeroallergens.

Cockroach Allergen Bla g 7 Promotes TIM4 Expression in Dendritic Cells Leading to Th2 Polarization

As one of the most common sources of indoor aeroallergens worldwide, cockroach is important in causing rhinitis and asthma while the mechanisms underlying remain obscure. Since T helper (Th) type 2 polarization plays an important role in the pathogenesis of allergic diseases, we investigated the effect of Bla g 7, a pan-allergen fromBlattella germanica(B. germanica), on Th polarization which is controlled by monocyte-derived dendritic cells (DCs). Challenged by recombinant Bla g 7 (rBla g 7), immature DCs obtained from human exhibited upregulated levels of TIM4, CD80, and CD86 and increased IL-13 secretion. Cocultured with CD4+ T cells, challenged DCs increased the ratio of IL-4+ versus IFN-γ+ of CD4+ T cells, suggesting a balance shift from Th1 to Th2. Moreover, antibodies against TIM4, CD80, and CD86 reversed the enhancement of IL-4+/IFN-γ+ ratio and alleviated the IL-13 release induced by rBla g 7, indicating that the Th2 polarization provoked by rBla g 7 challenged DCs is via TIM4-, CD80-, and CD86-dependent mechanisms. In conclusion, the present findings implied a crucial role of Bla g 7 in the development of cockroach allergy and highlighted an involvement of DCs-induced Th2 polarization in cockroach allergy.

CORRELATES OF RECURRENT WHEEZING IN SCHOOL-AGE CHILDREN

The authors conclude that major risk factors to develop recurrent wheezing in school-age children include the exposure to such aeroallergens as house dust mite, animal dander, particularly cat, and mold spores in addition to ETS. They feel that a reduction in indoor aeroallergens and ETS could reduce recurrent wheezing by 65% and they make a great case for implementing strong environmental control measures, praticularly in those with a strong family history of asthma.

Aeroallergens and Asthma

The main aeroallergens in both the indoor and outdoor environment that have been implicated in the pathogenesis of allergic asthma are reviewed. Pollen and fungal spores are important outdoor aeroallergens that cause sensitization in atopic subjects, leading to rhinitis and asthma in a proportion of the sensitized subjects. Each pollen type displays a particular seasonal periodicity: tree pollen are prevalent in the late winter and spring, grass in the spring and summer and weed mainly in the fall. There are regional differences in the type of pollen grains in Canada. Although the pollen grains arc large fragments less than 10 µ can reach the lower airways to cause asthma. Some fungal spores. such asAlternariaandCladosporium, have been implicated in asthma. The full clinical impact of fungi in asthma has yet lo be clarified. With the construction of homes that are tightly scaled to conserve heat and the use or wall to wall carpet. the type and concentration of indoor aeroallergens have become increasingly different from outdoors. House dust mite and pet allergens have now been shown to he important acro:dlergcns that sensitize children in infancy and are risk factors for asthma. Clinicians should recognize the importance of aeroallergens in asthma because avoidance and/or reduc1iun of exposure is an important part of the management besides drug therapy.