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Rhinitis is a chronic inflammatory disease of the upper respiratory tract, characterized by a high prevalence and a complex pathogenesis. Work-related rhinitis (WRR) can be divided into occupational rhinitis (OR) and work-exacerbated rhinitis (WER). It is not only considered as a disease entity but also in the context of medical certification as the allergic disease associated with occupational exposure. Epidemiology of work-related rhinitis has been found to vary depending on the occupation and specific exposure, on the other hand the prevalence data may be underestimated due to the lack of uniform diagnostic criteria. This paper reviews the issues comprising the pathogenesis, epidemiology, diagnosis and treatment of patients with work-related rhinitis. It also discusses the significance of the disease in occupational medicine, particularly in terms of preventive worker care, general principles of good practice in primary and secondary WRR prevention and the necessary directions of changes in medical certification in the cases of occupational rhinitis. Med Pr 2016;67(6):801-815., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Introduction: Measurement of PNIF is often used as a indicator in provocation studies or used for assessment the therapeutic effect of medicines. Unfortunately, there is a lack of norm for this parameter. Therefore, the aim of this study was to assess a few variables which are advisable to estimate the norm for PNIF measurements., Material and Methods: The study was a part of the ECAP study (The Epidemiology of Allergic Diseases in Poland). Study group was selected randomly: children aged 6-7, 13-14 and adults. Subjects were inhabitants of 8 cities: Białystok, Gdańsk, Katowice, Kraków, Lublin, Poznań, Warszawa i Wrocław and one village district: zamojski and krasnystawski. PNIF level had been measured among qualified respondents by In-Check inspiratory flow meter manufactured by Clement. Clark. PNIF level was measured before and after application of Oxalin (0,05%) aimed at improve patency of nasal passages. The study was conducted three times, the highest value was noted., Results: There were 4674 qualified subjects, of which 27,6% were children aged 6-7, 27,7%-children aged 13-14 and 44,7%-adults. Results were quantified by Statistica 10 programme and Microsoft Excel programme. Analysis were conducted in regards of sex, age, health status and study area. SEX: Statistically significant higher level of PNIF, as before as after application of medicine, were observed among man than woman. Average level of PNIF after application of medicine among adult man were 151,99 l/min (SD=61,73 l/min), boys aged 13-14-127,62 l/min (SD=53,0), boys aged 6-7- 54,44 l/min (SD=33,44 l/min). Average level of PNIF after application of medicine among adult woman were 119,31 l/min (SD= 45,71 l/min), girls aged 13-14- 109,13 l/min (SD=42,86 l/ min), girls aged 6-7- 61,35 l/min (SD= 31,56 l/min). AGE: There was observed statistically significant difference between age's groups. Average level of PNIF among adults were 131,91 l/min (SD=54,82 l/min), children aged 13-14- 118,68 l/min (SD=49,23 l/min), children aged 6-7- 64,27 l/min (SD=32,64 l/min). Health status: Statistically significant higher level of PNIF were observed among healthy people than sick subjects, among all age's group, except among children aged 6-7. Average level of PNIF, after application of medicine were following: among adults: sick - 128,94 l/min (SD=54,66 l/min), healthy-134,94 l/min (SD=54,84 l/min), children aged 13-14: sick- 116,73 l/min (SD=48,48 l/min), healthy- 120,68 l/min (SD=49,92 l/min) and children aged 6-7: sick- 64,8 l/min (SD=32,25 l/min), healthy- 63,79 l/min (SD=33,0 l/min). Also there was noted statistically significant difference between subject with periodic allergic rhinitis than chronic allergic rhinitis., Study Area: Statistically significant higher level of PNIF was observed among subjects living in urban area than rural area, as before as after application of medicine, among all age's groups., Conclusions: There were found statistically significant differences between age, sex, health status and study area. PNIF measurement is valuable study assessing. PNIF measurement is valuable parameter assessing rhinitis status.

Introduction: The aim of the study was to evaluate the results and 4-year own experience in the endoscopic treatment of the nose and paranasal sinuses., Material and Methods: In the Clinic of Otolaryngology and Laryngological Oncology of the Medical University of Lodz between 2006 and 2009 there were 603 endoscopic operations performed on patients with chronic paranasal sinusitis, including 287 females aged 17-80 and 316 males aged 18-87. The patients were qualified for the operation on the basis of an interview, objective otorhinolaryngological examination, frontal and transverse computerized tomography of the nose and paranasal sinuses, laboratory tests (blood cell count, sedimentation tests, urine tests, electrolytes tests). Moreover, allergological diagnostics (skin prick tests, intranasal provocation tests), a histopathological examination of the removed lesions and a culture of biological material from the paranasal sinuses were done. The 0 degree and 30 degrees endoscopes of Storz GMBH and Wolf and the video rotation microtome (debrider)., Results: Possible reasons for paranasal sinusitis were: viral infection (34.8%), anatomical disorders (28.5%), irritating factors like tobacco smoke (17.9%), allergy (13.4%), tumours (3.2%) and gastroesophageal reflux (2.1%). Finally, the following endoscopic operations were conducted: revision surgery of the maxillary sinuses in 680 cases (56.4%), ethmoidectomy in 586 cases (48.6%), polypectomy in 273 cases (22.6%), re-polypectomy in 232 cases (19.2%), sphenoid sinus revision in 229 cases (19.0%), frontal sinus revision in 80 cases (6.6%) and re-ethmoidectomy in 77 cases (6.4%). The average stay in the Clinic lasted 3.2 days., Conclusions: Advantages of the complex surgical treatment are found in both post-operative and pharmacological procedures. The FESS surgery should be only a minimally invasive technique, which subsequently could guarantee an effective treatment, slight post-operative complications, a short hospitalization period and a quick return of the patient to work, as it is proved by the own study.

Aim of the Study: The aim of the study was to assess management of patients with allergies, to evaluate frequency of use of specific antihistamines in population with diagnosed allergy, to evaluate causes and frequency of antihistamines' discontinuation, as well as frequency of allergen identification., Material and Method: This was a multi-centre, observational study, in the form of epidemiological registry. The study was conducted in 1200 centres all over the country. 23 997 patients with diagnosed allergic condition were enrolled into this study., Results: The most frequent allergic condition in the surveyed population was allergic rhinitis (51% of all enrolled patients), urticaria (28%), and allergic conjunctivitis (20%). Only 6 562 subjects (27%) had been examined with skin prick tests or specific IgE antibodies tests and their allergens had been identified. The remaining subjects had been treated so far with no attempts to identify allergy triggers (allergens). In the surveyed population, the dominant type was pollen allergy (62%) and house dust mites allergy (33%). Only 48% of subjects were on antiallergic treatment at the time of the enrollement into this epidemiological registry. The main causes of medication discontinuation were side effects observed, predominantly sedation., Conclusions: The most frequent allergic condition treated in outpatient setting is allergic rhinitis. Only 48% of allergic patients take antiallergic medicines (predominantly antihistamines). The most prevalent reason for treatment discontinuation are side effects, mainly sedation.

Introduction: This work aimed at the analysis of results of the treatment of nasal and paranasal sinus polyps by the endoscopic method., Material and Methods: The tests were conducted on 142 patients, including 75 women and 67 men at the age of 17-68, who underwent the endoscopic surgical treatment due to nasal polyps and paranasal sinus polyps between 2006-2007. In all the patients we conducted functional surgical procedures of the nose and paranasal sinuses by the endoscopic method. In the post-operative treatment we applied the nasal steroid therapy and guided antibiotic therapy. The efficiency of the treatment was assessed 6 months after the procedure., Results: All in all, we conducted 278 polipectomies (163 repolipectomies) of the nose, 278 ethmoidectomies (56 reethmoidectomies), 188 ostium-ductal complex operations, 43 maxillary sinus operations, 21 sphenoid sinus operations and 64 surgical dilatations of the sphenoid sinus ostinum, 49 surgical dilations of the frontal sinuses. In 7 cases the nasal septum operation was conducted simultaneously. Six months following the operation, the endoscopic test showed a correct patency in the ostinum of the paranasal sinuses, sphenoid and frontal sinuses, and no inflammatory traits like reddening, swelling of the nasal mucosa or any pathological secretion. Four times we noticed reddening and swelling of the nasal mucosa, and the mucopurpulent secretion accompanying correct patency of the ostinum in the paranasal sinuses. The control examination carried out 6 months after the surgical treatment showed, according to the patients, the appropriate nasal patency in 93.7%, sensation of the blood flowing down the throat in 20.4%, mucorrhoea in 2.8%, smell impairment in 17.6% and headache in 2.8%., Conclusions: In the majority of the cases we conducted nasal and paranasal sinus re-operations after the prior traditional procedures, which are still used in many institutions not equipped with endoscopic surgery appliances.

Surgical procedure is used in chronic rhinosinusitis and aims at restoring proper drainage and ventilation. For this reason the surgery of this region is referred to as functional and in English literature is termed as FESS. It supplanted classical method of Caldwell-Luc or Denker. In the study nine years experience in the Department of Otolaryngology, Head and Surgery University of Poznań in the treatment of chronic sinusitis has been presented. 1463 patients treated with FEES were analyzed. Moreover, the method of selecting patients for the surgery, the diagram showing surgeries performed step by step as well as a list of various surgeries and intraoperative complications were presented. This work is the first part of the study. In the other part the results of the treatment based on the questionnaires sent to patients will be presented.

Introduction: In this work we wish to emphasize the importance of postoperative care of patients who underwent FESS in ENT Department Medical University in Poznań. We feel that too little attention is still being paid to this treatment as we mostly focus on surgery., Material and Methods: Our observation are based on nine year experience in functional endoscopic sinus surgery. The analysis covers patients hospitalized in our Department from January 1998 to August 2007. The schedule of postoperative care has been presented., Results: 1463 FESS operation were carried out in our Department from January 1998 to August 2007. Similar postoperative procedures were used with each patient. Full recovery of mucous membrane depended on a few parameters such as: if the patient underwent FESS for the first time, what kind of changes were observed: polips or chronic infection, as well as the method of surgery ("aggressive" versus "delicate"). Healing time ranged from 6 week to 3 month., Conclusions: The scheme of procedures employed comes useful in postoperative treatment after FESS.

Purpose: Study of frequency of allergic rhinitis in selected regions of Poland in cities and countryside., Material and Methods: 8913 respondents, from Warszawa, Katowice, Lublin and Zamojszczyzna (countryside), answered a questionnaire based on ECRHS II and ISAAC. The respondents were drawn from PESEL ID numbers. They were divided into three groups: 6-7 years, 13-14 and 20-44 years, both sexes., Results: 21-23% adults living in the city and 12% living in the countryside confirmed some type of sensitization, including allergic catarrh. In children the same symptoms are more frequent and reported in 23-27% of those living in city and 17% of those living in the countryside. Sneezing, running or obstructed nose not related to cold, fever or flu were reported by 22% of the adults living in Zamojszczyzna and 33-42% of those living in the cities. The symptoms are reported in 20% children living in the countryside and 29-39% of those living in the cities. All of results are statistical significant., Conclusions: Study of frequency of allergic rhinitis in selected regions of Poland shows that results are similar with analysis on the world. Connection between urban development and occurrence of allergic rhinitis was confirmed. Allergic rhinitis is more frequently in group of people living in cities than people living on countryside. Probably allergic rhinitis is not integrally examined in adults group.

Passive smoking is the problem all of us but the most harmful is for health of the children. The work aims was the assessment of frequency of occurrence of disease symptoms in the respiratory system in children up to 7 years of age depending on exposure to passive smoking. 100 children admitted to the Regional Children's Hospital in Bydgoszcz were subject to research; all of them living in the Kujawsko-Pomorskie Voivodeship. Research was conducted from May until December 2003. Information concerning family and social situation of the group examined was gathered; also data on disease history and environment was taken. The most frequently occurring respiratory system diseases were: rhinitis--in 69 (69%) children, pharyngitis--in 59 (59%) patients, bronchitis--58 (58%) children, laryngitis--30 % cases, and pneumonia was observed in 23 (23%) children examined. The lowest number--only 3 (3%) persons had sinusitis. The effort was also taken to determine the relation between the frequency of occurrence of symptoms and chronic diseases in the respiratory system and exposure to passive smoking. Research showed that the frequency of occurrence of bronchitis and hoarseness remains in significant statistical relation with passive smoking.

Unlabelled: The aim of the study was to assess changes in asthma prevalence between 1994/1995 (study I) and 2001/2002 (study II). Standardized ISAAC questionnaire was used. Randomly assigned population of school children 6-7 and 13-14 yrs of age was surveyed in Kraków and Poznań., Results: The prevalence of wheezing ever increased significantly in group 6-7 yrs of age from 25.5% to 28.6% in Krakow and from 17.3% to 27.6% in Poznań, respectively in study I and study II. The similar rise was found in group 13-14 yrs of age in Krakow from 14.6% to 21.6%, in Poznań from 17.1% to 22.2%. In both age groups and in both centers the number of children with established asthma diagnosis increased: in group 6-7 yrs of age in Krakow from 4.0% to 5.8%, in Poznań from 1.3% to 5.9%; in group 13-14 yrs of age in Krakow from 2.3% to 6.8%, in Poznań from 2.0% to 5.2%. Analysis of current symptoms (in the last year) confirmed increasing prevalence of wheezing, wheezing after exercise and night cough in Poznań in both age group, in Krakow only in older children. In younger children in Kraków significant difference concerned only wheezing after exercise. The most frequent symptom reported by children was nocturnal cough in the last year., Conclusions: The prevalence of the asthma symptoms and established asthma diagnosis increased during last 7 years. However significant number of children presenting asthma symptoms remains still underdiagnosed.

Dysfunction of the upper and lower airways frequently coexists, and they appear to share key elements of pathogenesis. Data from epidemiologic studies indicate that nasal symptoms are experienced by as many as 78% of patients with asthma and that asthma is experienced by as many as 38% of patients with allergic rhinitis. Among patients with nasal polyps 27-51% have asthma. Polyps of nasal mucosa usually exacerbates symptoms of concomitant asthma. Studies also have identified a temporal relation between the onset of rhinitis and asthma, with rhinitis frequently preceding the development of asthma. Patients with allergic rhinitis and no clinical evidence of asthma commonly exhibit nonspecific bronchial hyperresponsivenes. The mechanisms upper and lower airway dysfunction are under investigation. They include nasal-bronchial reflex, mouth breathing caused by nasal obstruction, and pulmonary aspiration of nasal contents. Nasal allergen challenge results in increases in lower airway reactivity within 30 minutes, suggesting a neural reflex. Improvements in asthma associated with increased nasal breathing may be the result of superior humidification, warming of inspired air, and decreased inhalation of airborne allergens. Postnasal drainage of inflammatory cells during sleep also may affect lower airway responsiveness. The effective management of allergic rhinitis relieves symptoms of asthma. A link between allergic rhinitis and asthma is evident from epidemiologic, pathophysiologic, and clinical studies. The development of differential diagnosis of rhinitis has multiplied their present classifications. This article presents classifications of rhinitis connected with lower airways dysfunction.

The study population included children aged 6-7 and 13-14 years from primary schools in Kraków (2302 and 2967 children respectively) and Poznań (3132 and 4069 children respectively). The prevalence was assessed using ISAAC questionnaire. In younger age group the number of children with diagnosed asthma and presenting asthma symptoms was significantly higher in Kraków than in Poznań. In older age group higher percentage was observed in Kraków in relation to wheeze ever and nocturnal cough during last year. Pupils from Kraków had symptoms of allergic rhinitis and were diagnosed as allergic rhinitis more frequently than from Poznań. Symptoms suggestive for skin allergy were more often observed in Kraków, but the differences were significant in relation to symptoms during last year in both age groups and in relation to symptoms ever in older age group. Our study revealed discrepancy between the prevalence of symptoms of asthma and allergic rhinitis and the prevalence of established diagnosis.

The prevalence of sensitization to common inhalant allergens was assessed among schoolchildren using skin prick tests with standard allergen extracts. The results were analysed in relation to asthma and allergy suggestive symptoms. A positive reaction to at least one allergen was observed in 13.5% children. The most frequent was allergy to timothy, then to house dust mite, birch, mugwort, cat dander and dog dander. Children with wheezing, breathlessness and/or rhinitis had significantly more frequent positive test results compared to children without any complaints.

Many reports describe an increase in the incidence of allergies in recent years. Thus the epidemiological studies are necessary for efficacious prophylaxis. The aim of our study was to estimate the prevalence of allergic diseases in schoolchildren. Allergic rhinitis and/or conjunctivitis was observed in 16.7%. Atopic dermatitis occurred in 12.9% cases. We showed the discrepancy between the number of children with symptoms suggestive for asthma (wheezing--11.1%, breathlessness--19.4%, nocturnal cough--4.9%, exercise-induced cough--9.8%) and number of cases diagnosed as asthma (3.2%). Family history of allergy increased the risk of allergic diseases in studied population.