Ayse Baccioglu Kavut

Allergic and nonallergic rhinitis: the threat for obstructive sleep apnea

BACKGROUND Although allergic rhinitis (AR) is accepted as a risk factor for obstructive sleep apnea syndrome (OSAS), the role of nonallergic rhinitis (NAR) is unknown. OBJECTIVE To compare OSAS in patients with AR vs NAR. METHODS We performed an observational study in 48 adults with AR and NAR that included a review of rhinitis and sleep symptoms, skin prick test results, self-administered questionnaire (Epworth Sleepiness Scale and 36-Item Short Form Health Survey) findings, and all-night polysomnography records. RESULTS The most frequent sleep symptom was snoring. Patients with AR had a significantly longer sleep duration and better sleep efficiency than did those with NAR. Both groups had frequent arousals. OSAS was diagnosed in 36% of patients with AR and in 83% of those with NAR (P = .001). Severe OSAS existed only in the NAR group. NAR showed a high correlation with OSAS (odds ratio, 6.4) and with apneas (odds ratio, 0.2). Body mass index, sex, and coexisting asthma did not have any predictable effect on OSAS, but age was correlated with OSAS. The impairment in quality of life was similar in both groups. CONCLUSIONS Both AR and NAR are risk factors for a high apnea-hypopnea index, and both can predispose to sleep apnea. However, NAR seems to have a greater risk according to impaired polysomnography results and higher Epworth Sleepiness Scale scores. Therefore, patients with rhinitis should be treated not only for nasal symptoms but also for a better quality of sleep.

Comparison of azelastine versus triamcinolone nasal spray in allergic and nonallergic rhinitis

Background Intranasal antihistamine has not been thoroughly studied in the treatment of rhinitis of different etiologies. This study was designed to show the comparative efficacy of nasal antihistamine and nasal corticosteroid in patients with allergic rhinitis (AR) and nonallergic rhinitis (NAR). Methods A comparison of the efficacy of azelastine nasal spray (AZENS) versus triamcinolone acetonide nasal spray (TANS) on total nasal symptom scores (TNSS), nasal peak inspiratory flow rate (nPIFR), and nasal cytology was studied in a 2-week randomized parallel-group trial. The Epworth Sleepiness Scale (ESS) and health-related quality of life (HRQoL) were also analyzed. Results The study group consisted of 132 patients (100 women and 32 men) with a mean age of 33.14 ± 12.52 years. Sixty-nine patients had AR and 63 had NAR. Although TNSS including sneezing, itching, rhinorrhea, congestion—but not anosmia—significantly improved in both groups, intranasal azelastine reduced ocular symptoms greatly compared with intranasal triamcinolone (p = 0.05). Patients with NAR seemed to respond more to TANS, whereas AZENS was more useful in AR. The nPIFR improved in AR and NAR, with no significant difference between the treatment groups. Neither intranasal azelastine nor intranasal triamcinolone changed cytology in nasal lavage. Both medications were well tolerated, but AZENS led to more adverse events than TANS (56.9 and 19%, respectively; p = 0.001), mainly because of bitter taste. Scores on each domain of generic HRQoL (36-Item Short-Form Health Survey) and mini–rhinitis QoL questionnaires, as well as ESS score, significantly improved in both groups, irrespective of rhinitis etiology. Conclusions In this first comparative demonstration, AZENS appears to be as effective as triamcinolone in symptom scores, nPIFR, ESS, and HRQoL, equally in AR and NAR.

Allergic and Nonallergic Rhinitis: Can We Find the Differences/Similarities between the Two Pictures?

The diagnostic challenge of rhinitis is to determine the etiology, specifically whether it is allergic or nonallergic. We therefore evaluated the general features of patients with allergic (AR) and nonallergic rhinitis (NAR), as well as health-related quality of life (HRQoL). The study group consisted of 323 patients (201 F/122 M) with a mean age of 31.79 ± 12.64 years. Almost two thirds of the population had AR (63.5%). Neither the demographic characteristics nor the duration of rhinitis was different between the two groups. Total immunoglobulin E was significantly higher in AR. Although both groups displayed a mild-intermittent rhinitis profile, patients with AR had more seasonal and NAR had more perennial symptoms (p = 0.01). Frequency of nasal obstruction was comparable in both groups, whereas patients with AR significantly complained of rhinorrhea (86.8%), followed by nasal obstruction, sneezing, and nasal itching compared with the NAR group. Conjunctivitis and sinusitis were more prominent in the AR than NAR group (p = 0.01). However, the prevalences of asthma and bronchial hyperreactivity were not different, as well as the other allergic or systemic comorbidities. Furthermore, the impairment in HRQoL was similar in both groups, using a generic questionnaire- Short form-36 (SF-36). In conclusion, although the allergy test results still remain the only relevant difference, the diagnosis of NAR is important as it has many differences/similarities with AR and is seen almost half as often as AR in patients with chronic rhinitis.

The role of CD14 gene promoter polymorphism in tuberculosis susceptibility.

BACKGROUND CD14 is expressed principally by cells of monocyte/macrophage lineage and plays a pivotal role in the innate immunity to intracellular infections. Recent research findings have revealed an association between the CD14 gene promoter polymorphism and several major infectious diseases. OBJECTIVE The aim of the present study was to investigate the association between the CD14-159C/T polymorphism and tuberculosis in a Turkish population. METHODS For this purpose, 88 consecutive patients with tuberculosis (63 pulmonary, 25 extrapulmonary) and 116 control subjects were enrolled into a prospective study. We determined CD14-159 genotypes by polymerase chain reaction - restriction fragment length polymorphism analysis and also measured serum concentrations of soluble CD14 (sCD14) by using a quantitative sandwich enzyme immunoassay technique. RESULTS There was no significant difference in terms of genotype distribution between patients with tuberculosis (CC 18.2%, CT 48.9%, TT 33.0%) and controls (CC 12.9%, CT 50.9%, TT 36.2%) or between patients with pulmonary and extrapulmonary tuberculosis. Serum levels of sCD14 were significantly increased in patients with active tuberculosis compared to those with inactive tuberculosis and healthy controls (p<0.001). However, levels of sCD14 were not associated with any genotypes of CD14-159. CONCLUSION The genotyping findings of the present study do not support a role for the CD14-159C/T polymorphism in the development of tuberculosis, at least in the geographical region of central Anatolia. Significantly elevated serum sCD14 levels in patients with active disease reflect the importance of the mononuclear phagocytic system activation in tuberculosis.

Contribution of neurogenic and allergic ways to the pathophysiology of nonallergic rhinitis.

Background: A neuroallergic interaction was reported in the pathogenesis of allergic rhinitis (AR), but the pathophysiology of nonallergic rhinitis (NAR) is poorly understood. We aimed to explore the contribution of neuroallergic mechanisms to the pathogenesis of NAR. Methods: Subjects were divided into three groups – NAR patients (n = 25), AR patients (n = 16) and the control group (n = 10) – and were assessed using the nasal provocation test (NPT) with house dust mite. Total symptom scores, nasal inspiratory peak flow and nasal lavage were performed before and after NPT. Nasal brushing and scraping was done after NPT. Results: NPT was positive in NAR (52%) and AR (100%) patients and negative in all controls. After NPT, total symptom scores increased in both rhinitis groups. Post-NPT values of nasal inspiratory peak flow decreased only in AR patients. NAR patients showed a similar inflammatory cell profile in the nasal smears to AR patients which was different in controls. There were more tryptase- and immunoglobulin E (IgE)-positive cells in the nasal mucosa of AR patients, and more substance-p-positive cells were observed in NAR patients compared with controls. However, IgE- and tryptase-positive cells in NAR patients and substance-p-positive cells in AR patients were detectable in nasal mucosa, but rarely in the controls. Comparing the values before and after NPT, tryptase significantly increased in the nasal lavages of AR and NAR patients, while house dust mite-specific IgE did not change. Conclusions: We showed the existence of a common pathophysiological mechanism with different contributions in AR and NAR. We conclude that the difference in dominance of neuroallergic ways may determine the major phenotype of rhinitis.

Desensitization in Interferon-β1a Allergy: A Case Report

We report a 41-year-old patient with multiple sclerosis (MS) who was successfully desensitized after she developed non-injection-site urticaria and angioedema due to interferon (IFN)-β1a. Although a few cases of urticaria and anaphylaxis have been reported in the literature, to our knowledge this is the first report of a successful desensitization with IFN-β1a. Desensitization with IFN-β1a allowed us to continue with the administration of interferon-β, which is a mainstay in treatment for MS.

Impact of Asthma Education Meeting on Asthma Control Level Assessed by Asthma Control Test

BackgroundThe asthma control test (ACT) is a reliable tool to measure the level of asthma control. In our research, we aimed to investigate the effect of participation in an asthma awareness session on the patients perception of current asthma control as evaluated by ACT in relation to quality of life (QoL) in an adult population.MethodsAn observational study in subjects who were diagnosed as suffering with persistent asthma was performed. All asthmatic patients who were followed up in healthcare centers around the city were invited to the study. Patients who consented were informed about the study and then skin prick tests, pulmonary function tests, and blood analyses were performed. In addition, a self-administered generic QoL questionnaire (SF-36) was completed. Finally, the patients were invited to attend the asthma awareness session, and pre-post educational ACT assessments were evaluated.ResultsOverall asthma control was less than optimal in almost half of the study group. ACT level changed in 70.5% of the patients. The change in asthma control by using ACT was prominent in the ACT-deteriorated group than the ACT-improved group (-3.8 ± 2.7 and 2.1 ± 1.3, respectively; P = 0.001). Regarding comorbidities, the ACT-deteriorated group had the highest prevalence of rhinitis (P = 0.04). The impairment in QoL was similar between the groups and the physical domains of SF-36 were correlated with the ACT scores. The correlation between education level and asthma control was found to be significant after the training session (r = 0.353, P = 0.04).ConclusionEducation in asthma is an essential strategy not only to achieve awareness of asthma control level as assessed by ACT, but also for the reliability of QoL measurement.