Background: Allergic rhinitis (AR) is the most common IgE-mediated allergic disease. Multiple clinical trials have demonstrated promising results on the AR treatment with biologics, in particular with the use of omalizumab – an anti-IgE antibody. Omalizumab has also been established in the routine management of allergic asthma and chronic idiopathic urticaria. However, currently there is no approved license for the use of biologics in AR in Germany. Materials and methods: A systematic literature review has been completed including randomized controlled trials, meta-analyses, and reviews on the treatment of AR with omalizumab. Results: The systematic review demonstrates strong evidence supporting the use of omalizumab in the treatment of AR with regard to symptom control, safety profile, and management of comorbidities. Conclusion: Omalizumab is a good and safe option in the treatment of AR in terms of symptom control and the management of pre-existing comorbidities. Further clinical trials with other biologics in the management of AR are needed and are expected to follow soon.

Background/Aim: Cocaine is a widely used recreational drug and is known for its nasal complications including epithelial, cartilage and bone damage. The aim of the study was to analyze the impact of cocaine on ciliary beat frequency (CBF) of human nasal epithelial cells and therefore better understand its side effects on nasal mucosa. Materials and Methods: Nasal epithelial cells of 21 healthy subjects were harvested and exposed in vitro to cocaine hydrochloride solutions ranging from 0.875% to 7%. Highspeed video footage was acquired with phase contrast microscopy and CBF was analyzed with Sissons-Ammons Video Analysis (SAVA) software. Results: All tested concentrations led to a significant reduction in CBF compared to the control. Effects increased over time and with concentration. A mechanical inhibition of cilia by cocaine crystals was also observed. Conclusion: We assume that CBF reduction is part of the pathomechanism leading to nasal complications in cocaine abuse. Considering these results, clinical usage of cocaine should be critically evaluated and restricted to select cases only.The leaves of the Erythroxylum coca plant have been chewed by the indigenous people of South America long before the first isolation of cocaine in 1855 by Friedrich Gaedcke was successful (1). By using it, the native South Americans could work longer and harder on the fields due to its stimulating effects and endure hunger for longer periods of time. In 1884, Carl Koller introduced cocaine as a local anesthetic in ophthalmology (2). At present, more potent anesthetic derivatives like lidocaine mostly replaced cocaine in the medical field (3). Various commercial products containing cocaine like beverages and cigarettes have been sold until the early 20 th century. Due to its addictive nature and long-term side-effects, cocaine became outlawed for public use in most countries. Still, it is predominantly used as a recreational drug until today.The most common form is its water-soluble hydrochloride salt which can be swallowed, injected or sniffed. The effect of cocaine is based on the fact that 35-37% of applied cocaine is absorbed systemically by the nasal mucosa (4, 5). In 2017, approximately 18 million people world-wide consumed an average amount of 28,6 g of cocaine per year. Global cocaine use is still increasing and is centered in North America and Central and Western Europe (6).Cocaine causes a local anesthesia by blocking sodium-ion channels in peripheral nerves and leads to euphoria and psychological addiction by blocking the reuptake of dopamin, serotonin and noradrenaline in the central nervous system (CNS) (7, 8). Its sympathomimetic effects cause an elevated blood pressure and can promote arrhythmia and sudden cardiac death (9). In approximately 5% of cocaine users, the nasal application leads to cocaine induced midline destructive lesions (CIMDL) including hyposmia, crusting, ulcers, nasal septal perforation and bone erosion of the palate, skull base, orbita and paranasal sinuses (10).Different local and systemic fac...

Background Patients with recurrent epistaxis, particularly due to hereditary hemorrhagic telangiectasia (HHT) are recommended to apply topical tranexamic acid (TXA) to reduce bleeding events. Those patients may suffer ciliary dysfunction due to TXA’s effects on ciliary beating frequency (CBF) and their consequences. Methodology/principal Human nasal epithelial cells were harvested with a nasal brush in 30 healthy subjects. We investigated the CBF in RPMI medium using high-frequency video microscopy. TXA was added to the cells in various concentrations ranging from 2 to 5%, including the therapeutic concentration (2%) and a control (0%). Results CBF in the control condition was 6.1 ± 1.6 Hz. TXA reduces CBF in a time and concentration dependent manner, to, e.g. 4.3 ± 1.2 Hz with 2% TXA and 3.3 ± 0.9 Hz with 5% TXA after 16–20 min. The differences in CBF were statistically significant for all concentrations of TXA. Conclusions TXA has the potential to significantly impair nasal epithelial function. Therefore, frequent or regular topical nasal application of TXA should be done under close monitoring of nasal function, especially in patients with co-morbidities like chronic rhinosinusitis.

No abstract

MP 29-09 significantly reduced CB, with an almost linear relationship between the MP 29-09 concentration and reduction in CBF. For fluticasone propionate, a significant reduction of CBF was observed only at the highest analyzed concentration. The findings have implications for the long-term use of the MP 29-02. Yet, further clinical studies are needed to confirm these results in vivo, especially in patients with seasonal or perennial allergic rhinits.