Alfredo A. Jalowayski

Assessment of Upper Respiratory Tract and Ocular Irritative Effects of Volatile Chemicals in Humans

ABSTRACT Accurate assessment of upper respiratory tract and ocular irritation is critical for identifying and remedying problems related to overexposure to volatile chemicals, as well as for establishing parameters of irritation useful for regulatory purposes. This article (a) describes the basic anatomy and physiology of the human upper respiratory tract and ocular mucosae, (b) discusses how airborne chemicals induce irritative sensations, and (c) reviews practical means employed for assessing such phenomena, including psychophysical (e.g., threshold and suprathreshold perceptual measures), physiological (e.g., cardiovascular responses), electrophysiological (e.g., event-related potentials), and imaging (e.g., magnetic resonance imaging) techniques. Although traditionally animal models have been used as the first step in assessing such irritation, they are not addressed here since (a) there are numerous reviews available on this topic and (b) many rodents and rabbits are obligate nose breathers whose nasal passages differ considerably from those of humans, potentially limiting generalization of animal-based data to humans. A major goal of this compendium is to inform the reader of procedures for assessing irritation in humans and to provide information of value in the continued interpretation and development of empirical databases upon which future reasoned regulatory health decisions can be made.

Nasal Cytology In Clinical Practice

Analysis of the nasal cytology provides information regarding the pathophysiology and response to therapy of the airway. This paper reviews the techniques for obtaining and interpreting specimens. The discussion focuses on the epithelial and inflammatory cells and the patterns seen in allergic, infectious and structural nasal disorders.

Prevalence and Assessment of Qualitative Olfactory Dysfunction in Different Age Groups

The prevalence of parosmia and phantosmia among 363 chemosensory and nasal/sinus patients was studied, as was the accuracy with which our clinical questionnaire could assess these dysfunctions. We then investigated whether patients with parosmia or phantosmia, matched for odor intensity, perform poorer on odor identification than do patients with no dysosmia. More than 40% of the study group evidenced either parosmia (18.7%) and/or phantosmia (25.6%), a finding that suggests that more attention should be paid by the medical practitioner in addressing qualitative olfactory dysfunction. Furthermore, it appears that assessment of these dysfunctions may aid in differential diagnosis, and that questionnaires can be used with reasonable validity irrespective of the patients age. Finally, the results imply that parosmia may be reflected in a discrepancy between odor identification and detection.

Effect of desloratadine therapy on symptom scores and measures of nasal patency in seasonal allergic rhinitis: results of a single-center, placebo-controlled trial

BACKGROUND Desloratadine reduces symptoms and maintains nasal airflow in patients with seasonal allergic rhinitis (SAR) during experimental allergen exposure. OBJECTIVE To compare the effects of desloratadine and placebo on symptom scores, quality of life (QOL), and nasal airway patency in patients with SAR during the allergy season. METHODS Adults with symptomatic SAR were randomized in a double-blind manner to receive desloratadine, 5 mg, or placebo for 14 days. Patient-rated SAR symptoms were recorded twice daily (morning and evening). On days 1 and 15, SAR symptoms were scored jointly (investigator and patient), nasal airflow was measured using 4-phase rhinomanometry, and QOL and the overall condition of SAR were rated. Overall treatment response was scored on day 15. Adverse events were recorded. RESULTS At day 15, total symptom (P = .03) and total nasal symptom (P = .02) scores and patient morning-rated individual nasal symptom scores (except nasal stuffiness) (P < or = .04) decreased significantly from baseline with desloratadine vs placebo. Flow in the descending expiratory nasal airflow phase was significantly greater (P = .046) and the percentage increase in total inspiratory nasal airway resistance was less (P = .03) in the desloratadine group vs the placebo group. The overall condition of SAR was less severe (P = .045), the therapeutic response was greater (P = .004), and the nasal symptom domain of the QOL score was significantly better (P = .03) in the desloratadine group. Adverse event rates were similar in both groups. CONCLUSION Desloratadine treatment for 14 days improved nasal airflow and resistance as well as symptom and QOL scores in patients with symptomatic SAR during the allergy season.

The rhinologic evaluation of alzheimer's disease

Olfactory dysfunction is currently not listed among the NINCDS‐ADRDA clinical criteria for the diagnosis of Alzheimers disease. There is a large amount of psychophysical and neuropathologic evidence to suggest that patients with Alzheimers type dementia have olfactory system abnormalities. The rhinologic status of this group has not been characterized. The authors examined 21 Alzheimers patients and 21 age‐matched controls to determine whether 1. the Alzheimers group, in fact, had a diminished sense of smell, and whether 2. rhinologic factors were responsible for this nasal dysfunction. The findings support a neurologically mediated phenomenon as the cause for significant impairment in olfactory function in patients with probable Alzheimers disease.

Sensory and Associated Reactions to Mineral Dusts: Sodium Borate, Calcium Oxide, and Calcium Sulfate

Occupational exposure limits (OELs) for irritant dusts have had no quantifiable bases. This study (1) charted chemosensory feel, denoted chemesthesis here, to dusts of calcium oxide (1 to 5 mg/m3), sodium tetraborate pentahydrate [sodium borate] (5 to 40 mg/m3), and calcium sulfate (10 to 40 mg/m3); (2) examined correlates of the chemesthetic sensations; and (3) sought to illuminate the basis for potency. Twelve screened men exercised against a light load while they breathed air in a dome fed with controlled levels of dust for 20 min. Measured parameters included nasal resistance, nasal secretion, minute ventilation, heart rate, blood oxygenation, mucociliary transport time, and chemesthetic magnitude, calibrated to pungency of carbon dioxide. Subjects registered time-dependent feel from exposures principally in the nose, secondarily in the throat, and hardly in the eyes. Calcium oxide had the greatest potency, followed by sodium borate, with calcium sulfate a distant third. Of the physiological parameters, amount of secretion showed the best association with chemesthetic potency. That measure, as well as mucociliary transport time and minute ventilation, went into calculation of mass of dust dissolved into mucus. The calculations indicated that the two alkaline dusts increased in equal molar amounts with time. At equal molar concentrations, they had, to a first approximation, equal chemesthetic magnitude. On the basis of mass concentration in air or dissolved into mucus, calcium oxide and sodium borate differed in potency by a factor just above five, equal to the difference in their molecular weights. This relationship could inform the setting of OELs for a critical effect of irritation.

A Comparison of Nasal Cytology with Sinus X-Rays for the Diagnosis of Sinusitis:

A prospective comparison of nasal cytology with sinus x-rays in 55 patients (35 children and 20 adults) with suspected sinusitis was performed. A sample of the nasal mucosa from the inferior turbinate was obtained with a Rhinoprobe, fixed, and stained with modified Wright-Giemsa. The radiologist and the cytologist were unaware of each others findings. The x-ray report was considered positive if there was mucoperiosteal thickening, asymmetry, opacification, or air-fluid levels. The cytology report was positive if there was greater than 1 neutrophil per high power field with bacteria present. There was a 79% correlation between the sinus x-rays and nasal cytology reports. Specificity was 0.79 and sensitivity 0.79. When the cytology report was positive with greater than 6 neutrophils per high power field, the x-ray was positive 90% of the time. Two sinus x-rays were uninterpretable by the radiologists. These data indicate that nasal cytology is a safe, noninvasive and useful adjunct in the diagnosis of sinusitis in both adults and children.

Distribution of Specific Ventilation in Cystic Fibrosis

Continuous distributions of specific tidal ventilation were recovered from nitrogen washouts in 29 patients with cystic fibrosis and 22 normal subjects along with other pulmonary parameters to assess the utility of the recovered distribution in describing the progress of the disease. Normal subjects showed predominantly unimodal distributions of a pattern showing a small amount of ventilation going to units with high specific ventilation. Multimodal distributions were the rule in the cystic population with only subjects with normal pulmonary function having unimodal distribution.

Triamcinolone acetonide and fluticasone propionate aqueous nasal sprays significantly improve nasal airflow in patients with seasonal allergic rhinitis

Domiciliary measurement of nasal peak inspiratory flow rate (nPIFR) provides a simple, noninvasive, objective assessment of nasal patency and may be useful for determining the effectiveness of therapeutic interventions. This randomized, parallel-group, investigator-blind study compared the effects of triamcinolone acetonide aqueous nasal spray (TAA AQ), 220 microg everyday (n = 19), and fluticasone propionate (FP AQ), 200 microg everyday (n = 20), for 21 days on nasal airflow in patients with seasonal allergic rhinitis (SAR), using domiciliary nPIFR. Patients had a > or = 2-year history of springtime SAR and positive epicutaneous or intradermal test to grass, tree pollen, or outdoor molds. nPIFR was measured three times each morning (before dosing) and at bedtime using an In-Check nPIF meter. All measurements were recorded on diary cards, and the best of the three measurements was used for data analysis. There were no significant demographic differences between treatment groups at baseline. Baseline nPIFR (+/- SE) was 106.5 L/minute (+/- 51.2) and 97.7 L/minute (+/- 45.0) in the TAA AQ and FP AQ groups, respectively (p = 0.5733). Model-based estimation of mean change from baseline with TAA AQ and FP AQ at the end of the study were 21.72 (+/- 6.04) and 16.48 (+/- 5.73), respectively. Both treatment groups showed an approximately 20% improvement in nPIFR versus baseline (p = 0.0002 and p = 0.0069 for TAA AQ and FP AQ, respectively), with no statistical difference between treatments. Weekly mean nPIFR scores indicated progressive improvement in nasal airflow with both treatments. Both TAA AQ and FP AQ were effective for improving nasal airflow as indicated by increases in nPIFR in patients with SAR.