Nasal hyper-reactivity is a common feature in both allergic and nonallergic rhinitis

Segboer, Christine; Holland, Carlijn; Reinartz, Susanne M.; Terreehorst, Ingrid; Gevorgyan, Artur; Hellings, Peter W.; Drunen, Cornelis M. van; Fokkens, Wytske J.

doi:10.1111/all.12255

Cited by 77 publications

(74 citation statements)

References 35 publications

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“…Interestingly though, a higher proportion of children in the LAR (85.7%) group reported symptoms to at least one non‐specific NHR trigger as opposed to the AR (71.4%) and non‐LAR NAR (47.1%) group without this being statistically significant. It has been already reported that NHR cannot discriminate between NAR and AR, and our results extend this observation in LAR. These results indicate that it may be difficult for a clinician to distinguish the LAR children based on the clinical history alone.…”

Section: Discussionmentioning

confidence: 99%

Detection of local allergic rhinitis in children with chronic, difficult‐to‐treat, non‐allergic rhinitis using multiple nasal provocation tests

Tsilochristou

Kyriakakou

Manolaraki

et al. 2019

Pediatric Allergy Immunology

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Background There is little evidence on the incidence and characteristics of local allergic rhinitis (LAR) in children. Most studies have included subjects with perennial rhinitis only, and results are based on the investigation of no more than three allergens per study. Our aim was to determine the proportion of children with LAR amongst children with chronic, difficult‐to‐treat, perennial or seasonal, rhinitis but no evidence of sensitization to aeroallergens, or other alternative diagnosis. Methods We performed multiple nasal provocation tests (M‐NPTs) with four locally relevant aeroallergens (Phleum pratense, Olea europea, Alternaria alternata, and Dermatophagoides pteronyssinus) in children with absence of aeroallergen sensitization, seen during a calendar year in a specialized rhinitis clinic. We additionally performed single NPT to children with allergic rhinitis (AR; positive control group). The result of the NPT was based on symptoms and acoustic rhinometry. Identification of nasal hyper‐reactivity (NHR) triggers was through a questionnaire. Results Local allergic rhinitis was confirmed in 29.2% (7/24) of the negative SPT/blood testing population. All but one of the children reacted to one allergen and one to two. All AR children had positive single NPT with results similar to the LAR. There were no differences in age at examination and rhinitis onset, gender distribution, family atopy, and past or current environment of residency, while the prevalence of reported NHR triggers was comparable amongst the three groups. Conclusion This is the first pediatric study where the seasonal or perennial rhinitis population was thoroughly tested for LAR against four aeroallergens. LAR is present in a considerable proportion of children with chronic, difficult‐to‐treat rhinitis and no sensitization to aeroallergens, and therefore, the performance of NPT should be strongly considered in these cases. There were no distinct clinical characteristics between LAR, AR, and non‐allergic rhinitis in children.

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Section: Discussionmentioning

confidence: 99%

Detection of local allergic rhinitis in children with chronic, difficult‐to‐treat, non‐allergic rhinitis using multiple nasal provocation tests

Tsilochristou

Kyriakakou

Manolaraki

et al. 2019

Pediatric Allergy Immunology

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“…During exposure, there was an increase in blood flow specifically to the odour-sensitive brain regions, suggesting that a neurological response is critically involved in the pathogenesis of NAR [122]. Furthermore, recent results demonstrated that nasal hyper-reactivity is as common in NAR as in AR, but importantly, no inflammatory cells or mediators are present [123]. These data emphasize the non-inflammatory nature of this condition and suggest that in a subgroup of patients with non-allergic rhinitis, neuronal functional abnormalities may be responsible for their symptoms.…”

Section: Non-allergic Rhinitis Without Eosinophiliamentioning

confidence: 99%

Pathogenesis of rhinitis

Eifan

Durham

2016

Clin Experimental Allergy

294

213

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Summary:Rhinitis is a heterogeneous condition that has been associated with inflammatory responses as in allergic rhinitis but can also occur in the absence of inflammation such as in so-called 'idiopathic' (previously 'vasomotor') rhinitis. Allergic rhinitis affects approximately 1 in 4 of the population of westernised countries and is characterized by typical symptoms of nasal itching, sneezing, watery discharge and congestion. The intention of this review is to illustrate key concepts of the pathogenesis of rhinitis. Imbalance in innate and adaptive immunity together with environmental factors is likely to play major roles. In allergic rhinitis, initial allergen exposure and sensitization involves antigen presenting cells, T and B lymphocytes and results in the generation of allergen-specific T cells and allergen specific IgE antibodies. On re-exposure to relevant allergens crosslinking of IgE on mast cells results in the release of mediators of hypersensitivity such as histamine and immediate nasal symptoms. Within hours, there is an infiltration by inflammatory cells, particularly Th2 T lymphocytes, eosinophils and basophils into nasal mucosal tissue that results in the late-phase allergic response. Evidence for nasal priming and whether or not remodelling may be a feature of allergic rhinitis will be reviewed. The occurrence of so-called 'local' allergic rhinitis in the absence of systemic IgE will be discussed. Non-allergic (non-IgE mediated) rhinitis will be considered in the context of inflammatory and non-inflammatory disorders.Key words: Allergic rhinitis, non-allergic rhinitis, pathogenesis, priming, remodelling, Word count: 237. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Page 2 of 39 Clinical & Experimental Allergy Introduction:Rhinitis is a common heterogeneous chronic disorder in both children and adults that is defined as an inflammation of the nasal mucosa and characterised by the presence of one or more nasal symptoms that includes sneezing, itching, nasal discharge and nasal blockage.Allergic rhinitis is the most common form of non-infectious rhinitis that is associated with an IgE-mediated immune response against environmental allergens [1]. There are a number of rhinitis phenotypes that may be classified as shown in Table 1.The International Study of Asthma and Allergies in Childhood (ISAAC) revealed an increased worldwide trend of rhinitis with an average prevalence of 8-15% in children [2,3], with a prevalence in the general population ranging from 10-40% in industrialised countries [4][5][6][7]. Studies of the natural history of rhinitis in children have shown a prevalence of 2.8% and 11.8% at 4 years and 18 years of age for non-allergic rhinitis and, respectively, 3.4% and 27.3% for allergic rhinitis. The adjusted prevalence rate in adults was found to be 9.6% for non-allergic rhinitis and 29.8% for alle...

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“…It can be used to study nasal valve collapse , hormonal influences on the nasal mucosa and for the evaluation of nasal surgery outcome , and it has been recommended by many authors as a valuable objective instrument for evaluation of subjective nasal obstruction . PNIF can also be used in nasal provocation testing to evaluate nasal hyper‐reactivity and to evaluate environmental effects on nasal patency in occupationally induced nasal obstruction .…”

Section: Objective Measurements Of Nasal Airflow and Patencymentioning

confidence: 99%

Measurements of nasal airflow and patency: a critical review with emphasis on the use of peak nasal inspiratory flow in daily practice

Ottaviano

Fokkens

2016

Allergy

Self Cite

121

111

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Objective measures can be used to assist the clinician to diagnose and treat nasal obstruction and also to quantify nasal obstruction in research. Objective measurements of nasal obstruction are as important as objective measurements of lung function. peak nasal inspiratory flow (PNIF), acoustic rhinometry (AR) and rhinomanometry (RM), with their specific peculiarity, assess different aspects of nasal obstruction. From the studies available in the literature, it seems that these methods roughly correlate with each other and that all of them can be alternatively utilized very well in research as well as in clinical practice. This review describes the various methods that can be used to measure nasal patency, airflow and resistance, mainly peak nasal inspiratory flow, rhinomanometry and acoustic rhinometry. PNIF has been demonstrated to be reproducible and as good an indication of objective nasal patency as formal rhinomanometry and has the advantage to be cheap, simple and suitable for serial measurements and for home use even in the paediatric population. PNIF normative data are available for children, adults and elderly subjects, and the availability of unilateral PNIF normal values allows evaluation of nasal sides separately. Just as in the lower airways, objective and subjective evaluation gives different information that together optimizes the diagnosis and the treatment of our patients. We argue that PNIF should be used regularly in every outpatient clinic that treats patients with nasal obstruction.

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Nasal hyper-reactivity is a common feature in both allergic and nonallergic rhinitis

Abstract: We found no quantitative or qualitative differences in nasal hyper-reactivity between AR and NAR patients. It is not possible to differentiate NAR subpopulations based on physical or chemical stimuli.

Cited by 77 publications

References 35 publications

Detection of local allergic rhinitis in children with chronic, difficult‐to‐treat, non‐allergic rhinitis using multiple nasal provocation tests

Detection of local allergic rhinitis in children with chronic, difficult‐to‐treat, non‐allergic rhinitis using multiple nasal provocation tests

Pathogenesis of rhinitis

Measurements of nasal airflow and patency: a critical review with emphasis on the use of peak nasal inspiratory flow in daily practice

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