E. Holopainen

EFFECT OF DISODIUM CROMOGLYCATE ON SEASONAL ALLERGIC RHINITIS

Abstract Insufflation of disodium cromoglycate was compared with placebo insufflation in the prophylaxis of seasonal allergic rhinitis. The results of a double-blind trial in 27 patients suggest that insufflation of 10 mg. disodium cromoglycate into each nostril four times a day readily controls the symptoms of allergic rhinitis and considerably reduces the need for antihistamine therapy. The treatment is easy and well tolerated. No side-effects were noted in this trial.

Nasal Polyposis Relationships to Allergy and Acetylsalicylic Acid Intolerance

Allergological, clinical and histological findings in 109 unselected patients, treated for nasal polyps during the period Feb. 1977 to Feb. 1978 are reported. The material was divided into three groups according to clinical findings: 1) Atopy Group; 18 patients with positive history and skin test; 2) ASA Intolerance Group; 25 patients with a definite history of acetylsalicylic acid intolerance; and 3) Intrinsic Disease Group; 66 patients in whom specific etiological factors were not found. On skin testing, positive reactions were obtained in 42 patients. In 23 of the patients, the skin test result agreed with the history. Secretion and tissue eosinophilia, noted in 97 and 102 patients, respectively, correlated in 88% of the patients, whereas correlation with blood eosinophilia was poor (30%). The mean IgE level was 140 in the serum and 731 in the polyp fluid, serum values above 150 occurring in 28 out of 105 patients and fluid values above 150 in 58 out of 84 patients. The predominant histological finding in the polyp biopsies was tissue eosinophilia, which was most abundant in the ASA intolerance group. Squamous metaplasia was seen in 30% but it was marked only in 5 cases. In 10 patients ASA intolerance was confirmed by oral provocation.

Anamnestic Data in Allergic Rhinitis

In a study of 770 patients with allergic rhinitis, anamnestic data were collected by means of a questionnaire.

Nasal Reactions Elicited by Unilateral Allergen Challenge

Nasal reactions to unilateral allergen provocation were studied separately in both nasal cavities of 9 subjects with established seasonal allergic rhinitis. Three tests with the same allergen at the same concentration were performed in the same cavity at 48-h intervals. The parameters observed were clinical symptoms, changes in nasal airway resistance on rhinomanometry, and amount, weight and histamine content of the collected secretion. Nasal obstruction increased significantly on the provoked side but not contralaterally. Secretion increased symmetrically but the histamine content rose only on the provoked side. No priming effect was observed. The results are compatible with the view that the release of histamine has a 2-fold effect. Histamine directly caused vasodilatation of capacitance vessels and capillaries, which resulted in obstruction on the provoked side, and indirectly the histamine release led to stimulation of sensory nerve endings, which by triggering parasympathetic reflexes caused rhinorrhea in both nasal halves.

Experiences of treating allergic rhinitis with intra-nasal beclomethasone dipropionate. Short-term trials and long-term follow-up.

The effect of locally acting intra-nasal beclomethasone dipropionate was observed in 42 patients suffering from seasonal allergic rhinitis and 50 patients suffering from perennial rhinitis. The study consists of three parts: 1) a simple double-blind trial in seasonal rhinitis, 2) a double-blind crossover trial in perennial rhinitis, 3) a 1-year follow-up of the perennial group. The active drug was significantly superior to placebo when comparing subjective symptoms, nasal resistance and secretion eosinophilia in the patients. In long-term use it was possible to reduce the initial dose considerably. On objective examination no significant changes were seen in the epithelium following long-term use. No suppression of the hypothalamic-pituitary-adrenal axis was observed after 1 years regular use of beclomethasone dipropionate. The side effects were mild, the most common complaint being irritation of the nasal mucous membrane, apparently caused by the propellant gas.

Secretory otitis media and allergy. With special reference to the cytotoxic leucocyte test.

This study is an investigation on whether allergy, and especially food allergy, is more common in patients with secretory otitis media (SOM) than in others. At the same time, the effectiveness of the cytotoxic leucocyte test (CLT) as an aid in the diagnosis of food allergy was also studied. The material comprised 90 patients: 69 suffering from secretory otitis media and 21 without the disease as controls. Patients were studied using allergy history, ear status, tests for nasal and blood eosinophilic cells, total IgE, skin tests for 20 allergens, RAST for milk and wheat, immunoglobulin A, G and M, precipitating antibodies for milk and gluten, Mantoux test, and the CLT for 23 allergens. Allergy was found in 20% of the SOM patients and 10% of the control patients; the difference was not statistically significant. The best methods for verifying allergy were history, skin tests, and tests for nasal eosinophilic cells. Laborartory tests could not verify objectively that food allergy was more common among SOM patients than controls, although 16% of the SOM patients compared with none of the controls had a history of food allergy. Of the tests used, the CLT correlated best with a history of allergy, but the results of the different tests were not in accordance with each other.

Aspiration Cytology in Acute Otitis Media

One hundred and ninety-three middle ear effusion samples from patients with acute otitis media were studied for cellular content and bacteria. Findings were compared with clinical and radiological data. In samples positive for pathogenic bacteria (Haemophilus, pneumococci) neutrophils predominated, whereas monocytes or phagocytes were more numerous in samples with nonpathogens. Inflammatory cells were more frequent in large than in small mastoid air cell systems. Destruction of cell walls was associated with increase of neutrophils and sclerosis with preponderance of lymphocytes, monocytes and phagocytes.

Clinical trial of a two per cent solution of DSCG in perennial rhinitis.

The value of Disodium cromoglycate (DSCG) in the treatment of both seasonal and perennial rhinitis has been studied with a powder formulation applied to the nose by means of a specially designed insufflator (4, 5). Nasal provocation studies have been carried out using an aqueous solution of DSCG at a concentration of 2 per cent (7, 10). These studies have demonstrated a significant protection of the nasal mucosa against a subsequent challenge with either grass or birch poilen. In one study (10), the investigator assessed the duration of protection by repeated antigen challenges following a single dose of DSCG. The results showed that one dose of DSCG (approximately 1.6 mg) protected the nasal mucosa for at least 4 h. Consequently we decided to investigate the clinical effectiveness of a 2 per cent solution of DSCG administered as a fine spray 6 times daily during the waking hours.

The Most Important Allergens in Allergic Rhinitis

The distribution of allergens, found on thorough allergy work-up in a series of 770 patients with seasonal and perennial nasal symptoms, is reported. The percentages of positive reactions to grass, tree, and herb pollens were equally high (30--40%) but, clinically, pollens from grasses (Timothy, Alopecurus, Kentucky Blue and Meadow fescue), birch and mugwort (Artemisia) were the most important. In the Nordic countries house dust is evidently the commonest causative agent in perennial rhinitis but the heterogenous composition of house dust makes it difficult to determine potent allergenic factors. Sensitivity to house dust was present in 44% of the patients; a positive reaction to mite extract in only 10%. Animal danders were not found to be great importance in allergic rhinitis (13--18%). Reactions to moulds were observed in 9% of the patients.

cytological aspiration biopsy in otorh1nolaryngological practice a preliminary report with special reference to method

The material consists of 128 lesions in the head and neck, 52 of which were salivary—gland lesions. A Millipore—filter technique was used in collecting cyto—logical material. With this technique it is, on the other hand, possible to collect even very scanty amounts of cellular material, and, on the other, preservation of cells and good staining properties are ensured. So far, histological verification has been performed in 62 of these cases. As to malignancy, false positive diagnoses were made in 2.3 per cent and false negative diagnoses in 5.5 per cent of the cases.