Severe Persistent Allergic Rhinitis. Inflammation but No Histologic Features of Structural Upper Airway Remodeling

Eifan, Aarif O.; Orban, Nara; Jacobson, Mikila R.; Durham, Stephen R.

doi:10.1164/rccm.201502-0339oc

Cited by 40 publications

(38 citation statements)

References 41 publications

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“…It was shown that despite severe nasal symptoms and the presence of persistent upper airway allergic inflammation, there was no evidence of associated upper airway structural remodelling, as judged by the morphological features of the epithelium and basement membrane zone, nor by the appearances of the nasal blood vasculature and lymphatic vessels. Similarly, there was no evidence of excess collagen deposition in the nasal mucosa compared to healthy controls (Fig. ).…”

Section: Allergic Rhinitismentioning

confidence: 77%

Pathogenesis of rhinitis

Eifan

Durham

2016

Clin Experimental Allergy

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295

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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Section: Allergic Rhinitismentioning

confidence: 77%

Pathogenesis of rhinitis

Eifan

Durham

2016

Clin Experimental Allergy

Self Cite

295

213

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“…The WAO (World Allergy Organization) also suggest that the preventive benefits of AIT may be greater if initiated early in the course of the allergic disease, and that failure of pharmacological treatment is not an essential prerequisite for the use of AIT [18]. Several studies have reported that both airway remodeling and underlying allergic inflammation exist in patients with mild and moderate-to-severe AR [19,20]. Our study provided new evidence in real life to support the early application of AIT in AR patients, not only for the relief of symptoms but also to possibly improve the clinical response to the AIT itself.…”

Section: Discussionmentioning

confidence: 99%

Early Intervention Improves Clinical Responses to House Dust Mite Immunotherapy in Allergic Rhinitis Patients

Chen

Huang

et al. 2016

Int Arch Allergy Immunol

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Background: Allergen immunotherapy (AIT) is the unique causal treatment for respiratory allergy. As AIT is expensive and of long duration, the availability of a marker predicting AIT responders is of crucial relevance. Objective: To investigate clinical parameters correlated with effective AIT in allergic rhinitis (AR) patients. Methods: This is a prospective, nonrandomized open study in which a total of 284 AR patients who had received house dust mite (HDM) subcutaneous AIT were enrolled from January 2011 to December 2015, and then followed up for 3 consecutive years. Demographic data, clinical history, laboratory tests (specific and total IgE levels), symptoms score, concomitant medication, and adverse reactions during AIT were collected. An AIT responder patient was defined when a visual analog score (assessing global symptoms) had decreased by >30% compared to baseline and concomitant medication was equal to or less than before AIT. Results: Thirty-three patients dropped out, so 251 patients were analyzed; 175 (69.7%) patients were responders. This group had a higher baseline symptom score than the AIT nonresponder group (7.5 vs. 6.9). A significant negative correlation was found between AR symptom duration and the clinical response to AIT. Local reactions (LRs) during AIT had a positive correlation. Other variables such as a family history of atopy, combined asthma history, and the levels of specific and total IgE had no correlations with effective AIT. Conclusion: Early intervention with AIT helps to improve the efficacy of AR treatment. LRs might predict successful AIT. Highly symptomatic AR patients may develop increased clinical responses to AIT.

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“…In SAR, nasal biopsies at baseline showed increased overall BM thickness compared to healthy tissue, but 24 hours after allergen challenge, despite eosinophil influx, further increase in BM thickening did not occur. 73,74 Moreover, no change in epithelial thickness or submucosal collagen deposition was observed. In individuals with PAR and HDM sensitization, BM thickness was also comparable to the normal nasal mucosa 73 and no further increase following HDM provocation was noted.…”

Section: Remodellingmentioning

confidence: 93%

Upper and lower airway remodelling mechanisms in asthma, allergic rhinitis and chronic rhinosinusitis: The one airway concept revisited

Samitas

Carter

Kariyawasam

et al. 2017

Allergy

210

156

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Allergic rhinitis (AR), chronic rhinosinusitis (CRS) and asthma often co-exist. The one airway model proposes that disease mechanisms occurring in the upper airway may mirror lower airway events. Airway remodelling is the term used to describe tissue structural changes that occur in a disease setting and reflect the dynamic process of tissue restructuring during wound repair. Remodelling has been long identified in the lower airways in asthma and is characterized by epithelial shedding, goblet cell hyperplasia, basement membrane thickening, subepithelial fibrosis, airway smooth muscle hyperplasia and increased angiogenesis. The concept of upper airway remodelling has only recently been introduced, and data so far are limited and often conflicting, an indication that more detailed studies are needed. Whilst remodelling changes in AR are limited, CRS phenotypes demonstrate epithelial hyperplasia, increased matrix deposition and degradation along with accumulation of plasma proteins. Despite extensive research over the past years, the precise cellular and molecular mechanisms involved in airway remodelling remain incompletely defined. This review describes our current rather limited understanding of airway remodelling processes in AR, CRS and asthma and presents mechanisms both shared and distinct between the upper and lower airways. Delineation of shared and disease-specific pathogenic mechanisms of remodelling between the sinonasal system and the lung may guide the rational design of more effective therapeutic strategies targeting upper and lower airways concomitantly and improving the health of individuals with inflammatory airway diseases.

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Severe Persistent Allergic Rhinitis. Inflammation but No Histologic Features of Structural Upper Airway Remodeling

Cited by 40 publications

References 41 publications

Pathogenesis of rhinitis

Pathogenesis of rhinitis

Early Intervention Improves Clinical Responses to House Dust Mite Immunotherapy in Allergic Rhinitis Patients

Upper and lower airway remodelling mechanisms in asthma, allergic rhinitis and chronic rhinosinusitis: The one airway concept revisited

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