Exhaled and Nasal Nitric Oxide – Impact for Allergic Rhinitis

Antošová, Martina; Bencova, Alica; Mokrá, Daniela; Plevková, Jana; Pepucha, L; Buday, Tomáš

doi:10.33549/physiolres.934393

Cited by 17 publications

(27 citation statements)

References 35 publications

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“…In a study performed by Martina et al who examined FeNO and nNO, gender-related differences were found in the FeNO, but not in the nNO levels neither for control nor for allergic rhinitis groups [20]. In consistent with the literature, when our patients were evaluated according to their gender, female subjects in the AR group had significantly higher nNO levels compared to those of NAR group, but no such difference was found within the groups.…”

Section: Discussionsupporting

confidence: 83%

Can nasal nitric oxide be a biomarker to differentiate allergic and non-allergic rhinitis?

Kalpaklıoğlu

Baççıoğlu

Yalım

2021

Egypt J Otolaryngol

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Background Nasal nitric oxide (nNO), a noninvasive indicator for eosinophilic airway inflammation, has not been adequately studied in different types of rhinitis. The aim of this study was to compare nNO levels between allergic (AR) and non-allergic rhinitis (NAR). Patients were included based on their chronic nasal symptoms. Total nasal symptoms score (TNSS) were evaluated. nNO was measured transnasally with a flow of 5 ml/s from the nostril with an NO analyzer (NIOX MINO; Aerocrine, Sweden). Results were evaluated as parts per billion (ppb). Results Four hundred forty-three patients (277 F/166 M)—337 with AR (76%) and 106 with NAR (24%)—were assessed. Patients with AR had significantly higher TNSS, more severe disease, and longer duration of disease compared to NAR group. Allergic rhinitis had significantly higher nNO levels than NAR (370 ppb vs 290 ppb) (p = 0.001). Likewise, significant differences were observed in female gender, in patients with BMI ≥ 25 kg/m2 and those without sinusitis between the two groups. When nNO were further evaluated in comorbid asthma, patients with AR w/o asthma had the highest TNSS and had significantly higher nNO level (p < 0.001). NAR+A group, with the longest duration of rhinitis, was significantly older and had the lowest nNO level (p < 0.001). Conclusions This study showed that nNO levels were significantly higher in AR patients than NAR. Although there is no recommended standard threshold for nNO, this study confirmed the utility of nNO in differentiating AR and NAR in addition to its known fast and non-invasive advantages.

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Section: Discussionsupporting

confidence: 83%

Can nasal nitric oxide be a biomarker to differentiate allergic and non-allergic rhinitis?

Kalpaklıoğlu

Baççıoğlu

Yalım

2021

Egypt J Otolaryngol

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“…Individuals with allergic rhinitis (AR) frequently have co-existing asthma (estimated at 10-40%) (17), while another 45% of AR individuals without asthma have bronchial hyperresponsiveness (18), an intermediate step toward asthma development. Selected studies have observed that individuals with AR can have an abnormal pulmonary function test (PFT) (19)(20)(21)(22)(23)(24) and fractional excretion of nitric oxide (FeNO) (25)(26)(27)(28)(29) even in the absence of asthma, suggesting that pollen is an important trigger for lower airway inflammation. In addition, FeNO has been shown to increase in sensitized individuals at times of higher pollen counts (27) and has been associated with the number of positive reactions on the SPT (25).…”

Section: Study Rationale For the Six Health Outcomes Pulmonary Outcomesmentioning

confidence: 99%

Rationale and Design of a Panel Study Investigating Six Health Effects of Airborne Pollen: The EPOCHAL Study

Bürgler

Glick

Hartmann

et al. 2021

Front. Public Health

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Background: While airborne pollen is widely recognized as a seasonal cause of sneezing and itchy eyes, its effects on pulmonary function, cardiovascular health, sleep quality, and cognitive performance are less well-established. It is likely that the public health impact of pollen may increase in the future due to a higher population prevalence of pollen sensitization as well as earlier, longer, and more intense pollen seasons, trends attributed to climate change. The effects of pollen on health outcomes have previously been studied through cross-sectional design or at two time points, namely preceding and within the period of pollen exposure. We are not aware of any observational study in adults that has analyzed the dose-response relationship between daily ambient pollen concentration and cardiovascular, pulmonary, cognitive, sleep, or quality of life outcomes. Many studies have relied on self-reported pollen allergy status rather than objectively confirming pollen sensitization. In addition, many studies lacked statistical power due to small sample sizes or were highly restrictive with their inclusion criteria, making the findings less transferable to the “real world.”Methods: The EPOCHAL study is an observational panel study which aims to relate ambient pollen concentration to six specific health domains: (1) pulmonary function and inflammation; (2) cardiovascular outcomes (blood pressure and heart rate variability); (3) cognitive performance; (4) sleep; (5) health-related quality of life (HRQoL); and (6) allergic rhinitis symptom severity. Our goal is to enroll 400 individuals with diverse allergen sensitization profiles. The six health domains will be assessed while ambient exposure to pollen of different plants naturally varies. Health data will be collected through six home nurse visits (at approximately weekly intervals) as well as 10 days of independent tracking of blood pressure, sleep, cognitive performance, HRQoL, and symptom severity by participants. Through repeated health assessments, we aim to uncover and characterize dose-response relationships between exposure to different species of pollen and numerous acute health effects, considering (non-)linearity, thresholds, plateaus and slopes.Conclusion: A gain of knowledge in pollen-health outcome relationships is critical to inform future public health policies and will ultimately lead toward better symptom forecasts and improved personalized prevention and treatment.

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“…The diagnostic values of nasal NO in allergic rhinitis were reported in various patient populations [35,58,60,73,[78][79][80]. Because the measurement of nasal NO is noninvasive, easy to perform, and economical, it has become a popular and valuable test for the diagnosis of AR even in children [81].…”

Section: Increased Inos Activities In Armentioning

confidence: 99%

“…Interestingly, products with a bitter taste that are secreted from common microorganisms are detected by the receptors of upper-airway epithelial cells. These products elicit T2R (taste family 2 bitter receptor proteins)-activated downstream responses to enhance the production of NO with bactericidal activities [ 33 , 34 , 35 ]. Bacteriostatic or bactericidal effects of NO may be species-specific.…”

Section: Nos Activities In the Human Nose And Paranasal Sinusesmentioning

confidence: 99%

“…In addition, negative associations existed between the daily use of a nasal steroid or ICS and the nasal NO levels during follow-up periods. However, whether nasal NO measurements are useful and reliable enough to monitor the diagnosis and severity of AR and the clinical course remains an open question [ 35 , 73 , 96 ]. The low reliability of nasal NO measurements is caused by several factors, including the high variability in nasal NO values, anatomical variations in the nose structure, the presence of the nasal cycle, and the comorbidity of sinus disease [ 97 , 98 ].…”

Section: Allergic Rhinitismentioning

confidence: 99%

See 1 more Smart Citation

The Functional Diversity of Nitric Oxide Synthase Isoforms in Human Nose and Paranasal Sinuses: Contrasting Pathophysiological Aspects in Nasal Allergy and Chronic Rhinosinusitis

Kawasumi

Takeno

Ishikawa

et al. 2021

IJMS

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The human paranasal sinuses are the major source of intrinsic nitric oxide (NO) production in the human airway. NO plays several roles in the maintenance of physiological homeostasis and the regulation of airway inflammation through the expression of three NO synthase (NOS) isoforms. Measuring NO levels can contribute to the diagnosis and assessment of allergic rhinitis (AR) and chronic rhinosinusitis (CRS). In symptomatic AR patients, pro-inflammatory cytokines upregulate the expression of inducible NOS (iNOS) in the inferior turbinate. Excessive amounts of NO cause oxidative damage to cellular components, leading to the deposition of cytotoxic substances. CRS phenotype and endotype classifications have provided insights into modern treatment strategies. Analyses of the production of sinus NO and its metabolites revealed pathobiological diversity that can be exploited for useful biomarkers. Measuring nasal NO based on different NOS activities is a potent tool for specific interventions targeting molecular pathways underlying CRS endotype-specific inflammation. We provide a comprehensive review of the functional diversity of NOS isoforms in the human sinonasal system in relation to these two major nasal disorders’ pathologies. The regulatory mechanisms of NOS expression associated with the substrate bioavailability indicate the involvement of both type 1 and type 2 immune responses.

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Exhaled and Nasal Nitric Oxide – Impact for Allergic Rhinitis

Cited by 17 publications

References 35 publications

Can nasal nitric oxide be a biomarker to differentiate allergic and non-allergic rhinitis?

Can nasal nitric oxide be a biomarker to differentiate allergic and non-allergic rhinitis?

Rationale and Design of a Panel Study Investigating Six Health Effects of Airborne Pollen: The EPOCHAL Study

The Functional Diversity of Nitric Oxide Synthase Isoforms in Human Nose and Paranasal Sinuses: Contrasting Pathophysiological Aspects in Nasal Allergy and Chronic Rhinosinusitis

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