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BACKGROUND Leptin may play a critical role in airway inflammation. However, it has rarely been evaluated in rhinitis with different aetiology. This study aimed to compare the serum leptin levels between allergic rhinitis (AR) and nonallergic rhinitis (NAR). METHODS Patients with chronic rhinitis were classified due to skin prick (ALK-Abello/Madrid) and/or serum-specific immunoglobulin E tests (UniCAP 100-Pharmacia), against to aeroallergens if concordant with symptoms. RESULTS A total of 398 patients with a mean age of 29.03 years were recruited and grouped as AR and NAR. Mean serum leptin levels were similar in patients with NAR and AR, as well as in patients with and without asthma, but were significantly higher in females than males in both groups. Also, leptin levels were significantly higher in obese than nonobese patients in AR. In correlation analysis, leptin levels were found to be correlated with female gender, older age, and high body mass index (BMI) in the whole group. Despite the higher total nasal symptom score (TNSS) in patients with AR compared with NAR, there was no association of leptin levels with TNSS, severity and seasonality of symptoms, and allergen sensitization. In logistic regression analysis, younger age and high serum leptin levels were found to be independent predictors for the diagnosis of AR. CONCLUSIONS We conclude that female patients with high BMI are more prone to AR probably due to immunological effects of adipose tissue, in addition to hormonal factors. This study showed that leptin measurement has limited value as a sole diagnostic tool to differentiate AR and NAR.

Rhinitis is among the most common respiratory diseases in children. Nonallergic rhinitis, which involves nasal symptoms without evidence of systemic allergic inflammation or infection, is a heterogeneous entity with diverse manifestations and intensities. Nonallergic rhinitis accounts for 16%–89% of the chronic rhinitis cases, affecting 1%–50% (median 10%) of the total pediatric population. The clinical course of nonallergic rhinitis is generally rather mild and less likely to be associated with allergic comorbidities than allergic rhinitis. Here, we aimed to estimate the rate of coexisting comorbidities of nonallergic rhinitis. Nonallergic rhinitis is more prevalent during the first 2 years of life; however, its underestimation for children with atopic tendencies is likely due to low positive rates of specific allergic tests during early childhood. Local allergic rhinitis is a recently noted phenotype with rates similar to those in adults (median, 44%; range, 4%–67%), among patients previously diagnosed with nonallergic rhinitis. Idiopathic rhinitis, a subtype of nonallergic rhinitis, has been poorly studied in children, and its rates are known to be lower than those in adults. The prevalence of nonallergic rhinitis with eosinophilia syndrome is even lower. A correlation between nonallergic rhinitis and pollution has been suggested owing to the recent increase in nonallergic rhinitis rates in highly developing regions such as some Asian countries, but many aspects remain unknown. Conventional treatments include antihistamines, intranasal corticosteroids, and recent treatments include combination of intranasal corticosteroids with azelastin or decongestants. Here we review the prevalence, diagnosis, comorbidities, and treatment recommendations for nonallergic rhinitis versus allergic rhinitis in children.

Background The aim was to evaluate the relative proportion of Non-steroidal anti-inflammatory drug exacerbated respiratory disease (NERD) and other comorbidities, and their impact on the burden of outpatient visits due to allergic rhinitis (AR), non-allergic rhinitis (NAR), acute rhinosinusitis (ARS), and chronic rhinosinusitis with nasal polyps (CRSwNP) and without (CRSsNP). Methods We used hospital registry data of a random sample of 5080 rhinitis/rhinosinusitis patients diagnosed during 2005-2019. International Statistical Classification of Diseases and Related Health Problems (ICD10) diagnoses, visits, and other factors were collected from electronic health records by using information extraction and data processing methods. Cox's proportional hazards model was used for modeling the time to the next outpatient visit. Results The mean (+/- standard deviation) age of the population was 33.6 (+/- 20.7) years and 56.1% were female. The relative proportion of AR, NAR, ARS, CRSsNP and CRSwNP, were 33.5%, 27.5%, 27.2%, 20.7%, and 10.9%, respectively. The most common other comorbidities were asthma (44.4%), other chronic respiratory diseases (38.5%), musculoskeletal diseases (38.4%), and cardiovascular diseases (35.7%). Non-steroidal anti-inflammatory drug exacerbated respiratory disease existed in 3.9% of all patients, and 17.7% of the CRSwNP group. The relative proportion of subjects having 1, 2, 3 and >= 4 other diseases were 18.0%, 17.6%, 17.0%, 37.0%, respectively. All diseases except AR, ARS, and mouth breathing, were associated with a high frequency of outpatient visits. Conclusions Our results revealed a high relative proportion of NERD and other comorbidities, which affect the burden of outpatient visits and hence confirm the socioeconomic impact of upper airway diseases.

OBJECTIVES/HYPOTHESIS To assess the long-term (12-24 months) safety and effectiveness of cryoablation of the posterior nasal nerve as treatment for chronic rhinitis. STUDY DESIGN A multicenter, prospective, single-arm clinical study. METHODS The study was conducted from February 2017 to April 2020. Study endpoints included change from baseline in the reflective Total Nasal Symptom Score (rTNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), physician assessment of improvement using the Clinical Global Impression-Improvement (CGI-I), and the incidence of treatment-related adverse events. RESULTS Ninety-one participants completed the study through the initial 12-month study period. Sixty-two participants consented to the long-term follow-up with 57 completing the 24-month follow-up. Significant improvements in the total rTNSS were reflected in a median change from baseline of -3.0 or -4.0 at all timepoints (P

Rhinitis is inflammation of the mucous membrane inside the nose. The clinical symptoms of this disease include nasal congestion, sneezing, itching of the nose and roof of mouth, rhinorrhea, and mucus draining down the back of the throat. Both allergic and non-allergic factors can play a role in the development of rhinitis. The most commonly used classification of rhinitis includes allergic rhinitis, non-allergic rhinitis, infectious rhinitis, and its specific forms. Allergic rhinitis is classified into the intermittent or persistent types, and may also be classified as mild, moderate and severe according to the severity of symptoms. Treatment of allergic rhinitis includes elimination of contact with allergen, allergen-specific immunotherapy and pharmacotherapy, which is selected depending on the severity of the symptoms. Infectious rhinitis develops in acute viral infection, and rhinitis symptoms are present in acute and chronic rhinosinusitis. Non-allergic rhinitis comprises conditions ranging from vasomotor rhinitis and gustatory rhinitis to non-allergic rhinitis with eosinophilia syndrome. Mixed rhinitis has components of allergic and non-allergic rhinitis. In addition, there are CPAP rhinitis, occupational rhinitis, medication rhinitis, rhinitis in systemic administration of drugs, rhinitis of pregnant women, atrophic rhinitis, rhinitis in systemic diseases. The type of rhinitis is diagnosed based on the patient’s complaints, anamnesis and clinical picture, some cases require laboratory tests and CT scan of the paranasal sinuses to differentiate the diagnosis. Approaches to the treatment of rhinitis depend on its type and include elimination of allergens or provoking factors, administration of saline solutions, intranasal glucocorticosteroids, systemic antihistamines, intranasal cromones, decongestants, antibacterial drugs may be prescribed to treat infectious rhinitis. Rhinitis should be differentiated from structural abnormalities, including congenital features, acquired conditions, neoplasms, gastroesophageal reflux, nasal liquorrhea.

In the past decade, research in the molecular and cellular underpinnings of basic and clinical immunology has significantly advanced our understanding of allergic disorders, allowing scientists and clinicians to diagnose and treat disorders such as asthma, allergic and nonallergic rhinitis, and food allergy. In this review, we discuss several significant recent developments in basic and clinical research as well as important future research directions in allergic inflammation. Certain key regulatory cytokines, genes, and molecules have recently been shown to play key roles in allergic disorders. For example,interleukin-33 (IL-33)plays an important role in refractory disorders such as asthma, allergic rhinitis, and food allergy, mainly by inducing T helper (Th) 2 immune responses. Further, the cytokine TSLP has been shown to be a key factor in maintaining immune homeostasis and regulating inflammatory responses at mucosal barriers and targeting TSLP-mediated signaling is considered an attractive therapeutic strategy. We discuss interleukin 4 receptor pathways, which recently has shown to play a critical role among the allergic inflammatory pathways that drive allergic disorders and pathogenesis. The alarmin IL-33 has found to play a major role in type-2 immune responses in allergic diseases and clinical trials with IL33 inhibitors are underway in food allergy. Further, the cytokine Thymic Stromal Lymphopoietin (TSLP)has recently been shown a factor in maintaining immune homeostasis and regulating type-2 inflammatory responses at mucosal barriers in allergic inflammation. Also, new immune and genetic studies found that IL-4R pathways play a critical role among the allergic inflammatory pathways that drive allergic disorders and pathogenesis. In addition, new findings establish an important T cell-intrinsic role of Mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1) proteolytic activity in the suppression of autoimmune responses. We have seen how mutations in the filaggrin gene are significant risk factor for allergic diseases such as atopic dermatitis, asthma, allergic rhinitis, food allergy (FA), and contact allergy and hand eczema. We are only beginning to understand the mechanisms by which the human microbiota may be regulating the immune system, and how sudden changes in the composition of the microbiota may have profound effects, linked with an increased risk of developing chronic inflammatory disorders, including allergies. New research has shown the important but complex role monocytes play in such disorders as food allergies. Finally, we discuss some of the new directions of research in this area, particularly the important use of biologicals in oral immunotherapy, advances in gene therapy, multi-food therapy, novel diagnostics in diagnosing allergic disorders, and the central role that OMICS plays in creating molecular signatures and biomarkers of allergic disorders such as food allergy. Such exciting new developments and advances has significantly moved forth our ability to understand the mechanisms underlying allergic diseases for improved patient care.

Background Pregnancy-induced rhinitis (PIR) is a form of chronic non-allergic rhinitis not present before pregnancy that manifests itself during pregnancy with complete resolution of symptoms after delivery. Objective The objective of this ambidirectional longitudinal cohort study is to evaluate the prevalence of PIR and to investigate the appearance and character of its symptoms, and its impact on the quality of life. Methodology: Six hundred eighty-one (681) women were recruited in the study. They completed questionnaires about nasal symptoms a day after delivery and each woman with nasal symptoms was interviewed 30 days later and data on symptom duration and quality were recorded. Results The prevalence of PIR was 31.86% (N = 217), 47.14% (N = 321) women had no nasal symptoms and 21% (N = 143) of participants had prior sinonasal disease. The clinical presentation of pregnancy rhinitis included nasal obstruction as the most common symptom, followed by rhinorrhea, postnasal secretion, nose itching, sneezing, and hyposmia. The median duration of PIR was 4 months with their complete resolution of symptoms between 2th and 16th day after delivery in the majority of respondents. PIR was diagnosed significantly more often if the women carried a female child. PIR affected their quality of life during pregnancy in 53,9% women (N = 117), with an average VAS score of 8. It seems that pregnancy may affect the course of previously present sinonasal disease (allergic rhinitis, chronic rhinosinusitis, nonallergic rhinitis, or non-infectious rhinitis prior to the pregnancy). Conclusions PIR is a common clinical entity with a wide range of symptoms with a direct impact on the quality of life in pregnancy. We propose a new definition of pregnancy-induced rhinitis.

Introduction.Chronic nasal congestion caused by edema of inferior turbinate affect 20% of population and strongly influences their quality of life. Pharmacological treatment of chronic rhinitis is considered to be the first line therapy. However, if conservative treatment is not effective and clinical signs are not disappearing the question about relevant surgical treatment is arising. Nowadays there are many methods of exposure on mucosa of the inferior turbinate. Considering high incidence of the pathology surgical treatment is of current importance in modern otorhinolaryngology.Objective.Assessment of the effectiveness and comparison of the period of rehabilitation after submucosal laser destruction by laser beam with wavelength 1,56 and after submucosal destruction by radiosurgical instruments Ellman Surgitron with a frequency of 4 MHz in patients with chronic rhinitis.Methods.60 patients were included into the study aged from 18 to 80 years old with chronic rhinitis. All the patients were admitted to the department to perform surgical treatment. Semiconducted laser with wavelength 1,56 and radiosurgical instrument Ellman Surgitron with frequency of 4 MHz were applied to the treatment. We assessed SNOT20 score, endoscopic features, anterior active rhinomanometry and saccharin test results in all patients following the surgery.Conclusions.The data we have obtained provide the basis for choosing semiconductor laser as more effective and safe technique for the treatment of patients with chronic rhinitis.

Advances in understanding the pathogenic mechanisms of both rhinitis and chronic rhinosinusitis have resulted in new treatment options, especially for chronic rhinosinusitis. A review of relevant medical and surgical clinical studies shows that intranasal corticosteroids, antihistamines, and allergen immunotherapy continue to be the best treatments for chronic rhinitis. Dupilumab is the first biologic approved for chronic rhinosinusitis with polyps. Omalizumab, mepolizumab, and benralizumab may have a future role in the treatment of chronic rhinosinusitis. Novel corticosteroid delivery devices such as an exhalation delivery system for fluticasone and bioabsorbable sinus implants provide enhanced and localized distribution of corticosteroids. Surgical management tailored to the underlying disease process improves clinical outcomes in chronic rhinosinusitis with or without nasal polyposis. Advances in the understanding of the heterogeneous nature of rhinitis and rhinosinusitis have resulted in more precise treatments. Improving the understanding of different endotypes should provide better knowledge to determine appropriate current and new therapies to treat these diseases.

Purpose of Review Precision medicine (PM) represents a new paradigm in disease diagnosis, prevention, and treatment. The PM approach focuses on the characterization of different phenotypes and pathogenic pathways in order to allow the selection of specific biomarkers that will be useful in disease management. Rhinitis is a highly prevalent and heterogeneous disease, both in terms of underlying endotypes and clinical presentations. Therefore, to apply the PM principles to the various rhinitis subtypes rise as a meaningful strategy to improve evaluation and treatment. Recent Findings The technology of recombinant allergens has allowed molecular characterization of IgE reactivity of specific individual components of allergenic extracts. Recently published and ongoing clinical trials based on component resolved diagnosis (CRD) bring more precision to allergen immunotherapy for allergic rhinitis. Monoclonal antibodies against various cytokines involved in inflammatory allergic and nonallergic rhinitis endotypes show promissory results. Summary Better understanding of pathogenic pathways together with an accurate phenotype classification of patients presented with rhinitis symptoms contributes to point out clinical usefulness of biomarkers and other diagnostic tools, which leads to more accurate environmental control measures, personalized pharmacologic options, and new biological therapy developments.

Background Nasal saline irrigation has become standard of care in various sinonasal conditions, including allergic and nonallergic rhinitis, chronic rhinosinusitis, and in the postoperative patient. Evidence regarding the mechanisms and dynamics of liquid flow through the sinonasal cavity remains limited due to inadequate experimental models (cadaveric, 3-dimensional [3D] printed, imaging of labeled dyes and radioisotopes). We aimed to develop a computational fluid dynamics (CFD) model of nasal irrigation to demonstrate sinonasal surface coverage, residence times across the mucosal surfaces, and shearing force of irrigation. Methods A nasal cavity geometry derived from high-resolution paranasal sinus computed tomography (CT) scans of a healthy, unoperated, 25-year-old patient was created. CFD analysis was performed to assess the distribution of nasal irrigation from a tapered nozzle bottle at a forward head-tilt position of 45 degrees with a 2-second burst at 35 mL/second. Results The model demonstrates nasal irrigation from ipsilateral to contralateral with precise measures of velocity, pressure, wall shear stress, and mapping of surface coverage and residence times at specific locations and times. The nasal cavity experiences almost complete coverage of irrigation, while overflow from the nasal cavity facilitates moderate coverage of the ipsilateral maxillary (40%) and anterior ethmoid sinuses (30%). Negligible coverage of the sphenoid and frontal sinuses was noted. Conclusion Detailed physical mechanisms of liquid irrigation injected from a commonly used squeeze bottle were shown. Ipsilateral maxillary and ethmoid sinus penetration are primarily due to overflow rather than direct jet entry, confirming the recommendation of larger volumes of irrigation to "flood" the sinus ostia.

OBJECTIVE To assess the efficacy and safety of cryoablation of the posterior nasal nerve (PNN) for treatment of chronic rhinitis. METHODS This was a prospective single-arm trial of 98 adult patients at six U.S. centers with chronic allergic and nonallergic rhinitis. PNN cryoablation was performed in-office under local anesthesia using a handheld device. Patients discontinued use of intranasal ipratropium 3 days prior to treatment and throughout the study period. Reflective Total Nasal Symptom Score (rTNSS) was measured at pretreatment baseline and posttreatment at 1 month, 3 months, 6 months, and 9 months. The Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was completed at pretreatment and 3 months posttreatment. Adverse effects and postprocedure medication usage were recorded. RESULTS Ninety-eight procedures (100%) were successfully completed. rTNSS significantly improved over pretreatment baseline (6.1 ± 1.9) at 1 month (2.9 ± 1.9, P

Allergic rhinitis (AR) affects 23-30% of the European population with equal prevalence reported in Belgium. Despite guidelines on the correct use of effective treatment, up to 40% of AR patients remain uncontrolled. Allergen immunotherapy (AIT) has been shown to improve the level of control up to 84% of patients being controlled by AIT. Recently, new guidelines for AIT have been published, supporting the clinical evidence for effectiveness of various subcutaneous and sublingual products for AIT in patients who are allergic to airborne allergens. AIT in AR patients not only reduces nasal and/or ocular symptoms but also induces tolerance and has preventive potential. Adoption of AIT into daily clinical practice in Belgium and other European countries is hampered primarily by reimbursement issues of each of the single products but also by several patient- and physician-related factors. Patients need to be better informed about the effectiveness of AIT and the different routes of administration of AIT. Physicians dealing with AR patients should inform patients on tolerance-inducing effects of AIT and are in the need of a harmonized and practical guide that supports them in selecting eligible patients for AIT, in choosing evidence-based AIT products and in following treatment protocols with proven efficacy. Therefore, a stepwise and holistic approach is needed for better adoption of AIT in the real-life setting in Belgium. ispartof: CLINICAL AND TRANSLATIONAL ALLERGY vol:9 issue:1 ispartof: location:England status: published

Objective: The aim of this study was to assess the long-term effectiveness of quantic molecular resonance (QMR) in the treatment of inferior turbinate hypertrophy (ITH) in allergic and nonallergic rhinitis refractory to medical therapy. Methods: This study enrolled 281 patients, 160 males (56.9%) and 121 females (43.1%), mean age 37.8 ± 4.1 years, range 18 to 71. Fifty-four patients have been lost to follow up and have been therefore excluded from the final analysis. Based on skin prick test results, 69 patients were considered allergic (group A) and 158 nonallergic (group B). All subjects underwent before surgery (T0) and 3 (T1), 12 (T2), 24 (T3), and 36 months (T4) after QMR treatment to: 4-phase rhinomanometric examination, nasal endoscopy evaluation, and visual analogue scale to quantify the subjective feelings about nasal obstruction. Results: Subjective and objective parameters showed statistically significant improvement in both groups. Group B parameters not changed during follow-up, while group A showed significant worsening between T1 and subsequent assessments. T4 outcome indicates a better result in nonallergic patients. Conclusions: In accordance with the literature, our preliminary data validate QMR treatment as a successful therapeutic option for nasal obstruction due to ITH. Nonallergic patients had a very good T4 outcome. Allergic patients showed a worsening trend after 1 year probably due to other causes.

Background Nasal nitric oxide (nNO) levels in allergic rhinitis (AR), healthy people or nonallergic rhinitis (NAR) have shown contradicting results in previous studies. By meta‐analysis, we reviewed studies that measured nNO in AR patients to assess nNO's ability to discriminate AR from healthy people or NAR. Methods We systematically searched PubMed, Cochrane, Embase, Ovid, Web of Science, Wanfang Data, CNKI until December 15, 2020. Differences were expressed as standardized mean differences (SMD) with 95% confidence interval (CI), by random‐effects method. Results A total of 10 original studies with 561 AR patients, 327 healthy controls, 123 NAR patients were included in the narrative synthesis and 9 studies in the meta‐analysis. nNO in AR was significantly increased compared with healthy controls (SMD: 0.989; 95% CI: 0.402, 1.576; p = .001) or NAR (SMD: 0.680; 95% CI: 0.101, 1.259; p = 0.021). However, subgroup analysis based on measuring process and patient characteristics showed that no significant differences were detected in nNO between AR patients with nasal polyps or sinusitis or marked ostial obstruction and healthy controls. Conclusions nNO is a potential indicator for recognizing AR. Nasal polyps, sinusitis and marked ostial obstruction should be considered before nNO is applied to detect AR., Graphical abstract The meta analysis shows that nasal nitric oxide (nNO) in allergic rhinitis (AR) is significantly higher than healthy people and nonallergic rhinitis. However sinusitis, nasal polysis and marked ostial obstruction should be taken into consideration before nNO is applied to detect AR.

Rhinitis is classified as allergic or nonallergic. It presents with nasal congestion, nasal pruritus, posterior nasal drainage, rhinorrhea, and/or sneezing. During short procedures, nasal cannula administration of supplemental oxygen may be utilized to prevent hypoxia. Postprocedural rhinitis after intravenous sedation with supplemental nasal oxygen (PRAISE SNOG) - a noninflammatory variant of nonallergic rhinitis - has been observed in colonoscopy patients. Symptoms (sneezing and/or rhinorrhea with or without tearing) typically begin during emergence from sedation and persist for hours to days before resolving. A 66-year-old woman developed bilateral PRAISE SNOG following cataract extraction; her bilateral symptoms of nasal pruritus, rhinorrhea, and sneezing began immediately after awakening from sedation and spontaneously resolved within 24 hours. Mucosal irritation by the nasal cannula prongs that deliver the oxygen is a postulated pathogenesis for postprocedural rhinitis. Modification of the nasal prong composition (by using a soft silicon-based material), placement (by insertion prior to the induction of sedation and by not impinging on the nasal mucosa), and length (by trimming from 10 to two millimeters) are possible actions that might be initiated in order to prevent PRAISE SNOG.

Background Cryoablation of the posterior nasal nerve at the middle meatus has been shown to successfully treat nasal obstruction and symptoms of chronic rhinitis. Cryoablation of both the middle and inferior meatus has not yet been studied. Objectives To evaluate the safety and feasibility of cryoablation of the posterior nasal nerve at both the middle and inferior meatus locations to treat chronic rhinitis. Methods Participants underwent bilateral cryoablation of the posterior nasal nerve at both the middle meatus and inferior meatus and were assessed through 3 months post treatment. The primary endpoint is the change from baseline to 3-month follow-up in the reflective Total Nasal Symptom Score (rTNSS). Other assessments include additional patient-reported outcomes, physician assessment, and independent review and scoring of imaging. Results Thirty participants were enrolled at 3 US centers. There was a significant improvement from baseline in the median rTNSS (–4.0, P Conclusion Cryoablation at both the middle meatus and inferior meatus appears to be a safe and feasible option for treatment of chronic rhinitis. In this feasibility study, there is significant improvement in symptoms post treatment. Adverse events are minor and transient.

Background The diagnosis and treatment of nonallergic rhinitis with eosinophilia syndrome (NARES) remain controversial. The aim of this study was to evaluate whether Cystatin SN together with symptoms can be used to diagnose NARES and to measure the efficiency of medical treatment. Methods Seventy-five patients with chronic rhinitis (CR) and 18 control subjects were enrolled. Their clinical characteristics were reviewed and laboratory parameters were evaluated. The concentration of Cystatin SN in nasal secretions was determined using the enzyme-linked immunosorbent assay. The histological assessment of Cystatin SN in the nasal mucosa was conducted by hematoxylin and eosin staining. The logistic regression and receiver operating characteristic curves were used to assess the predictive value of parameters for NARES. Results Nasal obstruction, sneezing, loss of smell, and total visual analogue scale (VAS) score were significantly different among the patients with CR. In particular, olfaction score was higher in patients with NARES than in those without NARES (AR, LAR, or IR). Similarly, the Cystatin SN level was significantly different between the control subjects and patients with CR. After treatment for 2 weeks, the Cystatin SN level and VAS score were significantly decreased in the NARES group. The accuracy of Cystatin SN together with local sIgE and loss of smell to diagnose NARES was up to 0.987 (sensitivity, 100%; specificity, 93.1%). Conclusions Cystatin SN with local sIgE and loss of smell may serve as one of the reliable and alternative biomarkers for the diagnosis of NARES and be used to evaluate disease severity and NARES treatment efficacy.

Background Posterior nasal nerve (PNN) cryoablation is a novel surgical technique to address allergic and nonallergic rhinitis. Periprocedural pain has been reported after PNN cryoablation and there are no standardized protocols for optimal in-office local anesthesia. This study sought to evaluate the effect of gabapentin on patient discomfort following in-office PNN cryoablation. Methods Multi-institutional prospective analysis of patients undergoing in-office PNN cryoablation for allergic or nonallergic rhinitis between March 2018 and April 2019. Patients received local anesthesia with or without 600 mg oral gabapentin 1 hour preprocedure. Rhinitis diagnosis, demographics, and baseline disease-specific quality of life (mini-Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ] and Total Nasal Symptom Score [TNSS]) were recorded. Patient discomfort was measured by the pain visual analogue scale (VAS) posttreatment and rated 0 to 10 on an ordinal scale. Fisher's exact and Wilcoxon 2-sample tests were used to evaluate differences between the 2 groups. Results A total of 26 patients were enrolled (gabapentin n = 15, control = 11). Baseline TNSS scores in the gabapentin vs control group were median [25th percentile to 75th percentile]) 10 (7.5 to 11.0) and 9 (6.0 to 10.0) (p = 0.35). Baseline Mini-RQLQ scores in gabapentin vs control groups were 3.21 (2.0 to 4.0) and 2.92 (2.78 to 4.35) (p = 0.51). The median VAS pain scores at 5, 20, and 30 minutes in the gabapentin vs control group were 0.0 (0.0 to 2.0) vs 3.0 (1.0 to 4.0), 2.0 (0.0 to 3.0) vs 8.0 (6.0 to 10.0), and 1.0 (0.0 to 1.0) vs 5.0 (4.0 to 6.0) (p = 0.02, p = 0.0043, and p = 0.003, respectively). Conclusion Preprocedure gabapentin significantly reduces immediate and delayed postprocedural patient discomfort following PNN cryoablation.

Background The specific burden of work-related rhinitis (WRR) on quality of life (QoL) and work productivity has received little attention. Objective The aim of this study was to investigate to what extent WRR affects QoL and work productivity as compared with subjects with rhinitis unrelated to work and those without rhinitis. Methods This cross-sectional survey was conducted among workers randomly recruited at the time of their periodic occupational health visit in the French-speaking part of Belgium. The survey instruments consisted of rhinitis-specific and generic questionnaires: Mini-Rhinitis QoL Questionnaire, Medical Outcome Study Short Form-8, and Work Productivity and Activity Impairment-General Health questionnaire. Eligible participants were categorized into 3 groups: non-WRR (current nasal symptoms not related to work, n = 329); WRR (current rhinitis with ≥2 nasal symptoms at work, n = 161); and controls (no nasal symptom; n = 1155). Results WRR showed significantly lower scores in all domains of the Mini-Rhinitis QoL Questionnaire compared with non-WRR. Multivariate analysis confirmed that WRR exerted an independent adverse effect on rhinitis-specific QoL. Both WRR and non-WRR were associated with greater impairment in the physical and mental health components of the Medical Outcome Study Short Form-8 instrument and the overall work productivity compared with controls, whereas these outcomes were more impacted in WRR than non-WRR. Multivariate analyses demonstrated that both WRR and non-WRR had an independent adverse impact on the physical and mental health status and overall work productivity. Conclusion WRR has an incremental adverse impact on QoL and work productivity that should be addressed in order to reduce the global burden of rhinitis.

Background Data on mepolizumab in patients with severe eosinophilic asthma (EA) and comorbidities are needed to assess whether randomized controlled trial results are applicable in the real world. Objective To evaluate real-life effectiveness and the presence/absence of predictors of treatment response in patients with one or more comorbidities (nasal polyps, allergic rhinitis, gastro-esophageal reflux disease, nonallergic rhinitis with eosinophilia syndrome, obesity, bronchiectasis) who received mepolizumab (MEPO) for the treatment of severe EA. Methods We performed a single-center retrospective study in patients with severe asthma and presence of comorbidities treated with mepolizumab at the respiratory outpatient clinic, Policlinico-Vittorio Emanuele, Catania, Italy. Health records of 31 severe asthmatic patients were retrieved and analyzed. Asthma control test (ACT) score, blood eosinophil count, forced expiratory volume in 1 s (FEV1), FEV1% of predicted and FEV1/FVC (Forced Vital Capacity) ratio, oral corticosteroid (OCS) dosage, and exacerbations were recorded at baseline (T0), after 3 (T1), 6 (T3), 9 (T6), and 12 months (T12). Clinical response was defined when 3 of these 4 criteria were fulfilled: i) 30% exacerbation decrease; ii) 80% blood eosinophilia reduction; iii) 3 point ACT increase; iv) FEV1 increase ≥200 mL. Results 83.87% of patients were classified as responsive to MEPO treatment. Substantial depletion of the blood eosinophils (>80%) was found in 87.1% of patients, FEV1 > 200 mL was seen in 54.84% of patients, a 3-point ACT improvement from baseline was recorded in 80.65% 25 of patients and a 30% reduction of exacerbations rates was seen in 96.77% of patients. Moreover, the majority 38.71% of patients met 3/4 parameters after 12 months. Neither the comorbidities nor other characteristics (sex, BMI, age, smoking) influenced treatment response. Conclusions MEPO in patients with severe EA is effective regardless of the presence of comorbidities.

Objective: The aim of our study was to analyze the montelukast effectiveness in improving oculonasal symptoms, patient-reported outcomes (PROs), and eosinophilic biomarkers in patients with nonallergic rhinitis eosinophilic syndrome (NARES).Methods: We enrolled prospectively 80 symptomatic patients treated with 10 mg once a day of montelukast in mono-therapy for 2 months. All patients were investigated before and after treatment. Nasal symptoms (nasal obstruction, rhinor-rhoea, sneezing, nasal itching), ocular symptoms (redness/puffiness, watery eyes), and other PROs (olfactory dysfunction,difficulty going to sleep, nighttime awakenings, and nasal congestion on awakening) were scored by visual analogic scale. Thefollowing clinical scores were assessed: Total Nasal Symptom Score (T4NSS), Total Ocular Symptom Score (T2OSS), TotalSymptom Score of Patient-Reported Outcomes (TSS-PROs), and a Composite Symptoms Score (CSS). Patients were classified asresponders when a reduction of at least 50% of the CSS was observed. Before and after treatment, the eosinophilic biomarkersin nasal lavage were analyzed: nasal eosinophilia (number of eosinophils per high power field), eotaxin-1 and eotaxin-2.Results: Aft er tre atment, s ig nificant reductions were observed for all the symptom scores. Forty-two of 78 patients were con-sidered responders. A significant reduction of eosinophils in nasal mucosa and of levels of eotaxin-1 and eotaxin-2 in nasal lavagewere observed after treatment in responder patients. Patients with asthma had an increased probability to be responders.Conclusion: NARES patients may benefit from treatment with montelukast. In particular, the presence of concomitantasthma may be predictive of a greater efficacy.

The article presents the issues of epidemiology, pathogenesis and treatment of allergic rhinitis. It describes the various types of nonallergic rhinitis, the relationship of allergic rhinitis and rhinosinusitis polyposa, eosinophilic nonallergic rhinitis, and rhinitis medicamentosa. The leading role of topical glucocorticosteroids in the therapy of rhinitis including non-allergic is considered in detail.

BackgroundChronic rhinitis impacts 60 million Americans and is associated with significant costs for patients. Although medical treatments are first line, some patients require surgical intervention such as vidian or posterial nasal neurectomy. Previous reviews have investigated the role of surgical management in chronic rhinitis, but none have investigated a longstanding treatment with recent interest: cryotherapy.ObjectiveTo identify the safety, efficacy, and durability of treatment response of cryotherapy in treating chronic rhinitis.MethodsA systematic literature review was performed to identify studies that investigated the utility of cryotherapy in chronic rhinitis. Only studies with the primary objective of assessing the efficacy of cryotherapy on chronic rhinitis were included. Patients were classified as allergic rhinitis, nonallergic rhinitis (vasomotor rhinitis), or mixed rhinitis using the original author’s criteria. Data were extracted regarding reported complications, treatment efficacy, and length of follow-up.ResultsA total of 110 abstracts were identified, of which 15 were included in this review. Epistaxis and nasal obstruction were commonly reported complications. No serious adverse events were reported. For obstructive symptoms, “reduced” symptoms were reported in 63.4% to 100% of patients. In regard to rhinorrhea, reports of reduced symptoms were experienced from 77% to 100% of patients. Seven studies used only patient-reported improvements without stratifying results based on symptom type; general improvements ranged from 67% to 100%. Nine studies noted symptom improvement in nonallergic cohorts ranging from 67% to 97.5% of patients. Four studies noted improvement in allergic cohorts ranging from 63.4% to 80% of patients. Two studies noted improvement in patients with mixed pictures ranging from 92.5% to 100%.ConclusionsAlthough cryotherapy appears safe and efficacious, heterogeneous past investigations with low-quality evidence make strong, evidence-based recommendations difficult to make. Further study with validated metrics and controlled populations is certainly warranted and should be encouraged.

Introduction Allergic rhinitis (AR) is immunologically and morphologically related to disorders in the lower airway. We investigated the relationship between the anatomy of the intranasal cavity and small airway resistance in subjects with nonallergic rhinitis (NAR). Methods We enrolled 226 children who were 7 years old and participated in the Seongnam Atopy Project 2016. We evaluated nasal patency using acoustic rhinometry to measure the volume of the nasal cavity at 0-5 cm, and measured lung function of the lower airway using an impulse oscillometry system (IOS) and spirometry. We also performed skin prick tests for 18 aero-allergens, and measured blood total eosinophil counts (TEC) and rhinitis symptom scores for the previous month using a visual analog scale (VAS, range: 0-10). Results We examined 226 children, 71 (31.7%) with AR, and 62 (27.7%) with NAR. Nasal patency in children with AR (median: 8.28 mm3 , IQR: 7.07-9.83) was lower than that of healthy children (median: 9.3 mm3 , IQR: 7.69-10.64, P = 0.011). Multivariate regression analysis showed that nasal patency was inversely associated with IOS resistance at 5 Hz after adjustment for compounding factors (B = -0.005, SE = 0.0032, P = 0.041). Analysis of NAR subjects, according to quartiles of nasal patency and quartiles of small airway resistance (Rrs5), indicated that nasal patency decreased as Rrs5 increased (linear trend: P = 0.020). Conclusion Nasal symptoms and TEC negatively correlated with nasal patency. Children with AR and NAR who had poor nasal patency had increased small airway resistance.

Background Endoscopic posterior nasal nerve (PNN) resection has been described as an efficacious surgical treatment of allergic and nonallergic rhinitis, but the requirement for surgery under general anesthesia has limited its acceptance. We report the first series of patients treated for chronic rhinitis using a novel device designed for office-based cryosurgical ablation of the PNN. Methods Twenty-seven patients with chronic rhinorrhea and/or nasal congestion for >3 months were recruited (allergic or nonallergic rhinitis), with minimum rhinorrhea and/or congestion subscores of 2 as part of the Total Nasal Symptom Score [TNSS]). Under local anesthesia, the cryotherapy device was applied endoscopically to the posterior middle meatus and was used to freeze the PNN region bilaterally. Patients were followed up after 7, 30, 90, 180, and 365 days to assess TNSS. Results The procedure was successfully completed in 100% of patients, with no complications; 74% reported no or mild discomfort by the first postprocedure day. TNSS was reduced significantly at 30 days (mean ± standard deviation: 6.2 ± 0.5 at baseline, 2.6 ± 0.3 at 30 days, n = 27, p Conclusion Office-based cryotherapy of the PNN region is safe and well tolerated. Symptom scores were significantly decreased by 7 days postprocedure and remained lower at 30, 90, 180, and 365 days.

Gevaert, Philippe/0000-0002-1629-8468; Hox, Valerie/0000-0003-2390-294X; Demoly, Pascal/0000-0001-7827-7964; Hellings, Peter W/0000-0001-6898-688X; N.G., Papadopoulos/0000-0002-4448-3468; Van Gerven, Laura/0000-0002-5325-7956; Cingi, Cemal/0000-0003-3934-5092; Seys, Sven/0000-0002-4399-9892 WOS: 000413151200004 PubMed: 28474799 This EAACI position paper aims at providing a state-of-the-art overview on nonallergic rhinitis (NAR). A significant number of patients suffering from persistent rhinitis are defined as nonallergic noninfectious rhinitis (NANIR) patients, often denominated in short as having NAR. NAR is defined as a symptomatic inflammation of the nasal mucosa with the presence of a minimum of two nasal symptoms such as nasal obstruction, rhinorrhea, sneezing, and/or itchy nose, without clinical evidence of endonasal infection and without systemic signs of sensitization to inhalant allergens. Symptoms of NAR may have a wide range of severity and be either continuously present and/or induced by exposure to unspecific triggers, also called nasal hyperresponsiveness (NHR). NHR represents a clinical feature of both AR and NAR patients. NAR involves different subgroups: drug-induced rhinitis, (nonallergic) occupational rhinitis, hormonal rhinitis (including pregnancy rhinitis), gustatory rhinitis, senile rhinitis, and idiopathic rhinitis (IR). NAR should be distinguished from those rhinitis patients with an allergic reaction confined to the nasal mucosa, also called entopy or local allergic rhinitis (LAR). We here provide an overview of the current consensus on phenotypes of NAR, recommendations for diagnosis, a treatment algorithm, and defining the unmet needs in this neglected area of research.

Cough is the most common symptom of respiratory diseases. The results of management of chronic cough in adults are still unsatisfactory. Unexplained and difficult-to-treat chronic cough causes significant impairment in patients‘ quality of life. The results of recent studies suggest that speech therapy (speech language intervention) is one of the few methods which are usefull in management of persistent chronic cough. We present a case of a patient with chronic cough due to chronic nonallergic rhinitis and gastroesophageal reflux disease, who had been unsuccessfully treated for 18 years. In the patient speech therapy resulted in a significant decrease of cough severity and improvement of quality of life.

Background. Prevalence of rhinitis in athletes has frequently been studied and varies widely from 27% to 74%. The aim of this systematic review was to examine the prevalence of rhinitis in athletes, to specifically compare the evidence of rhinitis in land-based and aquatic athletes.Methods. Systematic search of MEDLINE, EMBASE, and the non-MEDLINE subset of PubMed was performed from inception to March 8, 2016, to identify studies on rhinitis in athletes.Results. Of the 373 identified unique articles, a total of 13 studies satisfied the criteria for this review. The final group contained 9 cohort and 4 case-control studies. We found 10 studies that reported the prevalence of allergic rhinitis (21%–56.5%). In contrast, nonallergic rhinitis was identified by only 1 author (6%). We have also evaluated the prevalence of rhinitis in the separate subgroups (land, water, and cold air) where swimmers seem to be the most affected (40%–74%), followed by cross-country skiers (46%) and track and field athletes (21 to 49%).Conclusion. We did not reveal any convincing trend of a higher prevalence in land-based athletes compared to general population. By contrast, aquatic and cold air athletes demonstrate increased prevalence reflecting the irritant effects of their environment on the nasal mucosa.

Epidemiological associations have been made between the new onset of childhood rhinitis/asthma and exposures to elevated ambient levels of ozone, a commonly encountered gaseous air pollutant. Our laboratory was the first to find that mice repeatedly exposed to ozone develop nasal type 2 immunity and eosinophilic rhinitis with mucous cell metaplasia. More recently, we have found that these ozone-induced upper airway alterations are mediated by group 2 innate lymphoid cells (ILC2s) and not by T and B cells that are important in adaptive immune responses typically associated with allergic rhinitis and asthma. Furthermore, repeated exposures of mice to ozone cause ILC2-mediated type 2 immunity and airway pathology in the lungs, like those found in the nasal airways. Our recent findings in ozone-exposed mice complement and extend previous reports of nonallergic nasal airway disease in ozone-exposed rats and nonhuman primates. Overall, these experimental results in laboratory animals suggest a plausible ILC2-dependent paradigm for the toxicologic pathobiology that underlies the development of nonallergic rhinitis/asthma in children who live in environments with repeated occurrences of high ambient concentrations of ozone.

The specialties of allergy and clinical immunology have entered the era of precision medicine with the stratification of diseases into distinct disease subsets, specific diagnoses, and targeted treatment options, including biologicals and small molecules. This article reviews recent developments in research and patient care and future trends in the discipline. The section on basic mechanisms of allergic diseases summarizes the current status and defines research needs in structural biology, type 2 inflammation, immune tolerance, neuroimmune mechanisms, role of the microbiome and diet, environmental factors, and respiratory viral infections. In the section on diagnostic challenges, clinical trials, precision medicine and immune monitoring of allergic diseases, asthma, allergic and nonallergic rhinitis, and new approaches to the diagnosis and treatment of drug hypersensitivity reactions are discussed in further detail. In the third section, unmet needs and future research areas for the treatment of allergic diseases are highlighted with topics on food allergy, biologics, small molecules, and novel therapeutic concepts in allergen‐specific immunotherapy for airway disease. Unknowns and future research needs are discussed at the end of each subsection.

Persistent nasal pruritus (NP) represents a diagnostic and therapeutic challenge. A subgroup of nonallergic rhinitis (NAR) patients do not respond to intranasal corticosteroids and capsaicin, demanding evaluation of new therapeutic modalities in these non-responders. Agents for the treatment of neuropathic pain, like gabapentin, have been proposed as effective antipruritic agents. We report the case of a 52-year-old man with persistent NP refractory to treatment. Here, administration of gabapentin provided relief from NP and improved the quality of sleep. Gabapentin might be a therapeutic option for the treatment of NP in patients who are refractory to other treatments. Keywords: Nasal pruritus, Itch, Nonallergic rhinitis, Gabapentin

Background No diagnostic criteria have been available for nonallergic rhinitis (NAR) to this point in time. Nonspecific nasal hyperresponsiveness (NHR), which could be efficiently assessed by cold dry air (CDA) provocation, is an essential feature of NAR. Thus, this study's purpose was to assess the diagnostic value of CDA provocation in discriminating patients with NAR from healthy individuals. Methods CDA provocation was performed among 13 healthy volunteers and 15 NAR patients. Nasal symptom scores, total nasal volume (TNV), total nasal resistance (TNR) and minimal cross-sectional area (MCA) were checked before and after the provocation. Non-paramedic tests and receiver operating characteristic (ROC) curves were used in data evaluation. Results Subjects in the NAR group showed significantly larger changes after CDA provocation in total nasal symptom score (TNSS) and nasal congestion score compared with healthy volunteers, while the change for rhinorrhea score was comparable. Similarly, significant differences in the change of MCA and TNV were witnessed between both groups. We built a predictive model for NAR, Y = minus 3.285 plus 2.520 times the difference of TNR (%) plus 1.027 times the difference of TNSS minus 6.542 times the difference of TNV (%), whose area under curve was 0.93. According to the Youden index, the criterion was set to be Y greater than -0.52, when its sensitivity and specificity were 93.3% and 84.6%, respectively. Conclusions With superior patient-friendliness, safety and efficacy, we successfully performed the first NAR predictive model in the Chinese population, based on a short protocol of CDA provocation, by means of both subjective scores and objective tests (acoustic rhinometry and rhinomanometry).