7 research outputs found
Prevalence of asthma, aspirin sensitivity and allergy in chronic rhinosinusitis: data from the UK National Chronic Rhinosinusitis Epidemiology Study
Background: Chronic rhinosinusitis (CRS) is a common disorder associated with other respiratory tract diseases such as asthma and inhalant allergy. However, the prevalence of these co-morbidities varies considerably in the existing medical literature and by phenotype of CRS studied. The study objective was to identify the prevalence of asthma, inhalant allergy and aspirin sensitivity in CRS patients referred to secondary care and establish any differences between CRS phenotypes. Methods: All participants were diagnosed in secondary care according to international guidelines and invited to complete a questionnaire including details of co-morbidities and allergies. Data were analysed for differences between controls and CRS participants and between phenotypes using chi-squared tests. Results: The final analysis included 1470 study participants: 221 controls, 553 CRS without nasal polyps (CRSsNPs), 651 CRS with nasal polyps (CRSwNPs) and 45 allergic fungal rhinosinusitis (AFRS). The prevalence of asthma was 9.95, 21.16, 46.9 and 73.3% respectively. The prevalence of self-reported confirmed inhalant allergy was 13.1, 20.3, 31.0 and 33.3% respectively; house dust mite allergy was significantly higher in CRSwNPs (16%) compared to CRSsNPs (9%, p < 0.001). The prevalence of self- reported aspirin sensitivity was 2.26, 3.25, 9.61 and 40% respectively. The odds ratio for aspirin sensitivity amongst those with AFRS was 28.8 (CIs 9.9, 83.8) p < 0.001. Conclusions: The prevalence of asthma and allergy in CRS varies by phenoytype, with CRSwNPs and AFRS having a stronger association with both. Aspirin sensitivity has a highly significant association with AFRS. All of these comorbidities are significantly more prevalent than in non-CRS controls and strengthen the need for a more individualised approach to the combined airway
Prevalence of asthma, aspirin sensitivity and allergy in chronic rhinosinusitis: data from the UK National Chronic Rhinosinusitis Epidemiology Study
Background: Chronic rhinosinusitis (CRS) is a common disorder associated with other respiratory tract diseases such as asthma and inhalant allergy. However, the prevalence of these co-morbidities varies considerably in the existing medical literature and by phenotype of CRS studied. The study objective was to identify the prevalence of asthma, inhalant allergy and aspirin sensitivity in CRS patients referred to secondary care and establish any differences between CRS phenotypes. Methods: All participants were diagnosed in secondary care according to international guidelines and invited to complete a questionnaire including details of co-morbidities and allergies. Data were analysed for differences between controls and CRS participants and between phenotypes using chi-squared tests. Results: The final analysis included 1470 study participants: 221 controls, 553 CRS without nasal polyps (CRSsNPs), 651 CRS with nasal polyps (CRSwNPs) and 45 allergic fungal rhinosinusitis (AFRS). The prevalence of asthma was 9.95, 21.16, 46.9 and 73.3% respectively. The prevalence of self-reported confirmed inhalant allergy was 13.1, 20.3, 31.0 and 33.3% respectively; house dust mite allergy was significantly higher in CRSwNPs (16%) compared to CRSsNPs (9%, p < 0.001). The prevalence of self- reported aspirin sensitivity was 2.26, 3.25, 9.61 and 40% respectively. The odds ratio for aspirin sensitivity amongst those with AFRS was 28.8 (CIs 9.9, 83.8) p < 0.001. Conclusions: The prevalence of asthma and allergy in CRS varies by phenoytype, with CRSwNPs and AFRS having a stronger association with both. Aspirin sensitivity has a highly significant association with AFRS. All of these comorbidities are significantly more prevalent than in non-CRS controls and strengthen the need for a more individualised approach to the combined airway
Uso de analgésicos e antiinflamatórios em pacientes portadores de polipose nasossinusal eosinofílica tolerantes e intolerantes à aspirina Use of analgesics and anti-inflammatory drugs in patients with eosinophilic nasal polyposis tolerant and intolerant to aspirin
Com a introdução da aspirina como medicamento foram descritos diversos relatos de reações adversas. A associação de intolerância aspirínica (IA), polipose nasal (PNS) e asma foi inicialmente observada por Widals et al.(1922)¹, e posteriormente Samter & Beers (1967)². Esta intolerância se manifesta principalmente por obstrução nasal e/ou broncoespasmo, decorrente da inibição da ciclooxigenase-1 (COX-1) e conseqüente aumento de leucotrienos (LT). A intolerância também ocorre após a ingestão de outros antiinflamatórios não-esteróides (AINE), analgésicos, acetaminofen, corantes e aditivos alimentares e álcool. OBJETIVO: Analisar o risco do uso de analgésicos e antiinflamatórios em pacientes tolerantes e intolerantes à aspirina. Forma de Estudo: Estudo de coorte transversal. MATERIAL E MÉTODO: Selecionou-se 45 pacientes não alérgicos, sendo 15 pacientes portadores de polipose nasossinusal eosinofílica tolerantes a aspirina (grupo TA), 15 pacientes portadores de polipose nasossinusal eosinofílica associada a IA, manifestada por broncoespasmo (grupo IA), e 15 pacientes sem polipose nasossinusal, que apresentavam desvio de septo nasal (grupo controle). A pesquisa de reações aos analgésicos (aspirina, dipirona e acetaminofen), a outros AINE, ao álcool, aos corantes e aditivos alimentares bem como de alguma outra droga ou químico, foi realizada através de interrogatório. Para se confirmar a ausência de IA no grupo TA e controle realizou-se teste de provocação oral a aspirina. RESULTADOS: Broncoespasmo foi a principal reação à aspirina nos pacientes portadores de polipose nasossinusal eosinofílica e esta manifestação ocorreu também com uso de acetaminofen (20%), álcool (27%), antiinflamatório não-esteróides (47%) e dipirona (47%). CONCLUSÃO: Nos pacientes portadores de polipose nasossinusal intolerantes à aspirina o diagnóstico de intolerância a outras drogas é importante. É também destacada a intolerância a dipirona e ao álcool, respectivamente, em quase metade e um terço destes pacientes.<br>Following aspirin introduction as medicine, several reports were described concerning adverse reactions after its ingestion. Widal et al. (1922)¹ were the first investigators to associate Aspirin intolerance (AI) with asthma and nasal polyps (NP) followed by Samter & Beers (1967)². Such intolerance was manifested mainly by nasal obstruction and/or bronchospasm related to the cyclooxygenase-1 (COX-1) inhibition and consequent overproduction of leukotrienes. This might also be triggered by the administration of other non-steroid anti-inflammatory drugs, acetaminophen, food dyes and additives and alcohol. AIM: To analyze the risks of the analgesics and anti-inflammatory drugs use in patients with eosinophilic nasal polyposis tolerant and intolerant to aspirin. STUDY DESIGN: Transversal cohort study. MATERIAL AND METHOD: 45 patients were selected # 15 suffering from eosinophilic nasosinusal polyposis, tolerant to aspirin (group TA); other 15 with eosinophilic nasosinusal polyposis associated with aspirin intolerance (group AI), and 15 patients without nasosinusal polyposis with septal deviation (control group). The presence of reaction to aspirin, dipyrone, acetaminophen, other non-steroids anti-inflammatory drugs, food dyes and additives, other drugs or chemical substances was detected by inquiry. To exclude aspirin intolerance in TA and control groups, oral provocation test with aspirin was carried out. RESULTS: Bronchospasm was the main aspirin reaction in patients suffering from eosinophilic nasosinusal polyposis and which also showed with ingestion of acetaminophen (20%), alcohol (27%), non-steroids anti-inflammatory drugs (60%) and dipyrone (47%). CONCLUSION: In patients with eosinophilic nasosinusal polyposis associated with aspirin intolerance it is important to do the diagnosis of intolerance to other drugs. The use of dipyrone and alcohol is worth attention, once its intolerance was observed in half and one third of the patients, respectively
Mechanisms and mediators of nasal symptoms in non-allergic rhinitis
Non-allergic rhinitis may be a contributing factor in up to 60% of rhinitis patients and a sole contributor in a quarter. It is a highly heterogeneous condition with poorly understood pathophysiological mechanisms. Compelling evidence is emerging of a localized nasal mucosal allergic response in some non-allergic rhinitic subjects in the absence of systemic atopy. While the inflammatory disease pathway in non-allergic rhinitis may share some of the features of its allergic counterpart, overall the mechanisms remain unclear, and there are likely to be differences. In particular, symptoms of nasal congestion and rhinorrhoea tend to be more prominent and persistent in non-allergic rhinitic patients compared with allergic rhinitis. Our aim is to review the literature relating to mechanisms and mediators of nasal symptoms in non-allergic rhinitis. Better understanding of the underlying pathophysiological basis should enable the development of more accurate testing, and better targeted therapeutic options in the future
Perfil de citocinas e tipificação de HLA em pacientes com polipose nasossinusal tolerantes e intolerantes a aspirina Cytokines profile and HLA typing in tolerant and non-tolerant patients to aspirin with nasossinusal polyposis
A infiltração eosinofílica do pólipo nasossinusal (PNS) associado à intolerância aspirínica (IA) é característica relevante. Diversos mediadores participam da migração dos eosinófilos para os tecidos. A IA decorre do aumento da síntese de leucotrienos em indivíduos geneticamente susceptíveis. OBJETIVO: Analisar o perfil de citocinas e a tipificação de HLA-A, B e DR em pacientes com PNS tolerantes e intolerantes à aspirina. FORMA DE ESTUDO: Estudo de coorte transversal. MATERIAL E MÉTODO: selecionando-se 45 pacientes: 15 portadores de PNS eosinofílica tolerantes à aspirina (grupo TA); 15 de PNS eosinofílica associada à intolerância aspirínica, manifestada por broncoespasmo (grupo IA) e 15 sem PNS, que apresentavam desvio de septo nasal (grupo controle). O perfil de citocinas (IL-2; IL-4; IL-5; IL-6; IL-8; IL-10; IFN-gama e TNF-alfa) foi pesquisado nos fragmentos de pólipo nasal ou de mucosa de concha média (grupo controle) através da reação reversa da cadeia de polimerase (RT-PCR). A tipificação de HLA-A, B e DR foi realizada através de teste sorológico de microcitotoxicidade ou por amplificação de DNA pela reação em cadeia da polimerase (PCR). RESULTADOS: A expressão de RNAm para as interleucinas 4, 5, 6, 8, 10, IFN-gama e TNF-alfa foi semelhante nos três grupos. A expressão de RNAm para IL-2 associou-se com a IA. Os pacientes portadores dos antígenos A11, B49, DR15 e DR13 apresentaram uma maior probabilidade de desenvolver polipose nasossinusal não relacionada à IA, enquanto os portadores de DR17 apresentaram uma maior probabilidade de desenvolver polipose nasossinusal associada à intolerância aspirínica (Tríade Aspirínica). CONCLUSÃO: A polipose nasossinusal associada à intolerância aspirínica (Tríade Aspirínica) mostrou associação significante com HLA- DR17 e IL-2, sugerindo um perfil de citocinas TH1.<br>The eosinophilic infiltration in the nasosinusal polyp associated with intolerance to aspirin is predominant feature. Several mediators play a role in the migration of the eosinophils to the tissues. The IA may be due to overexpression of leukotrienes in genetically susceptible subjects. AIM: The purpose of this study was to evaluate the cytokine pattern and HLA-A, B and DR typing in subjects with PNS tolerant and intolerants to aspirin. STUDY DESIGN: A transverse cohort study. MATERIAL AND METHOD: was conducted on 45 patients: 15 patients suffering from eosinophilic PNS and aspirin tolerance (group TA); 15 from eosinophilic PNS associated with aspirin intolerance, the latter manifested by bronchospasm (group IA), and 15 without PNS who had nasal septum deviation (control group). Cytokine pattern (IL-2; IL-4; IL-5; IL-6; IL-8; IL-10; IFN-gamma and TNF-alpha) was evaluated in samples from the nasal polyp or midlle turbinate mucosa (control group) of the patients using reverse transcription-polymerase chain reaction (RT-PCR). HLA-A, B and DR typing was performed using the serum microcytotoxicity test or by DNA amplification using polymerase chain reaction (PCR). RESULTS: mRNA expression for interleukines 4, 5, 6, 8, 10, IFN-gamma and TNF-alpha was similar in the three groups. mRNA expression for IL-2 was associated with IA. Patients with antigens A11, B49, DR15 and DR13 had a higher likelihood of developing PNS not-related to intolerance to Aspirin, whereas patients with DR17 had a higher likelihood of developing PNS associated with intolerance to Aspirin (Aspirin Triad). CONCLUSION: PNS associated with intolerance to Aspirin (Aspirin Triad) shows a significant association with HLA- DR17 and IL-2, suggesting a TH1-lymphocyte-activation pattern