P. Van Cauwenberge

Differentiation of chronic sinus diseases by measurement of inflammatory mediators

Background:u2002 Chronic rhinosinusitis (CRS) clinically is a heterogeneous group of sinus diseases, which may cover different disease entities, or may represent a disease continuum. Studying inflammatory cells and mediators in clearly defined disease subgroups may lead to a better differentiation of chronic sinus diseases.

Standard skin prick testing and sensitization to inhalant allergens across Europe--a survey from the GALEN network

Skin prick testing (SPT) is the standard method for diagnosing allergic sensitization but is to some extent performed differently in clinical centres across Europe. There would be advantages in harmonizing the standard panels of allergens used in different European countries, both for clinical purposes and for research, especially with increasing mobility within Europe and current trends in botany and agriculture. As well as improving diagnostic accuracy, this would allow better comparison of research findings in European allergy centres. We have compared the different SPT procedures operating in 29 allergy centres within the Global Allergy and Asthma European Network (GA2LEN). Standard SPT is performed similarly in all centres, e.g. using commercial extracts, evaluation after 15–20u2003min exposure with positive results defined as a wheal >3u2003mm diameter. The perennial allergens included in the standard SPT panel of inhalant allergens are largely similar (e.g. cat: pricked in all centres; dog: 26 of 29 centres and Dermatophagoides pteronyssinus: 28 of 29 centres) but the choice of pollen allergens vary considerably, reflecting different exposure and sensitization rates for regional inhalant allergens. This overview may serve as reference for the practising doctor and suggests a GA2LEN Pan‐European core SPT panel.

Prevalence, classification and perception of allergic and nonallergic rhinitis in Belgium

Background:u2002 Allergic rhinitis (AR) and noninfectious, nonallergic rhinitis (NINA) are common disorders, which may prompt patients to seek medical help.

Viruses and bacteria in acute asthma exacerbations--a GA² LEN-DARE systematic review

To cite this article: Papadopoulos NG, Christodoulou I, Rohde G, Agache I, Almqvist C, Bruno A, Bonini S, Bont L, Bossios A, Bousquet J, Braido F, Brusselle G, Canonica GW, Carlsen KH, Chanez P, Fokkens WJ, Garcia‐Garcia M, Gjomarkaj M, Haahtela T, Holgate ST, Johnston SL, Konstantinou G, Kowalski M, Lewandowska‐Polak A, Lødrup‐Carlsen K, Mäkelä M, Malkusova I, Mullol J, Nieto A, Eller E, Ozdemir C, Panzner P, Popov T, Psarras S, Roumpedaki E, Rukhadze M, Stipic‐Markovic A, Todo Bom A, Toskala E, van Cauwenberge P, van Drunen C, Watelet JB, Xatzipsalti M, Xepapadaki P, Zuberbier T. Viruses and bacteria in acute asthma exacerbations – A GA2LEN‐DARE systematic review. Allergy 2011; 66: 458–468.

Local immunoglobulin production in nasal polyposis is modulated by superantigens

Background Chronic rhinosinusitis (CRS) with nasal polyps (NP) represents a persistent inflammation often characterized by local hyper‐immunoglobulinaemia and the presence of specific IgE to Staphylococcus aureus enterotoxins (SAEs). We aimed to study the systemic and local production of Igs in relation to plasma cells, B cells and specific IgE to SAEs.

Staphylococcus aureus enterotoxins: a key in airway disease?

Staphylococcus aureus (S. aureus), one of three pathogenic species of the Gram-positive cocci, is often found as part of the normal microflora of the human skin, the upper respiratory tract, especially the vestibulum nasi, and the intestinal tract. Transmission of the organism is frequently achieved by direct contact with an infected individual, although it may also be airborne or infect via fomites. It is thought that about 25% of the population are permanent carriers of S. aureus and whilst approximately 20% of all human staphylococcal infections are autogenous, several factors have been identified that predispose the host to increased susceptibility to infection by S. aureus (1). These include injury to skin or mucous membrane, abnormal leukocyte function, viral infections (e.g., influenza), metabolic abnormalities (e.g., diabetes mellitus and uraemia) and miscellaneous conditions (e.g., malnutrition, old age, malignancies, etc.). Under appropriate conditions, the organism leads to a variety of clinical conditions, affecting the skin, lungs, heart, central nervous system (CNS), bones and joints, gastrointestinal tract and the blood system (1). Skin infections, lung abscesses, pneumonia, osteomyelitis, food poisoning, fever, scalded skin syndrome and toxic shock syndrome are among the most common conditions. Although the pathogenicity of S. aureus is closely correlated with the production of coagulase enzymes, and many conditions result as a consequence of invasion by the bacterium, these organisms also contain a number of cellular antigens and produce a variety of toxins with superantigenic properties (2, 3). Recent studies of these staphylococcal superantigens have demonstrated that they can influence the activity of both immunomodulatory and pro-inflammatory effector cell types, and therefore may have a potentially important role in the pathogenesis of chronic inflammatory disease.

Neutrophil‐Derived Metalloproteinase‐9 Predicts Healing Quality after Sinus Surgery

Background: In a recent study, we have shown that gelatinase‐B (metalloproteinase [MMP]‐9) in nasal secretions can have both monitoring and predictive value on the healing outcome after functional endoscopic sinus surgery (FESS) to treat chronic rhinosinusitis (CRS) and nasal polyposis (NP). In this work, we aimed to explore the source of MMP‐9 and the influence of inflammation on MMP‐9 expression and release in nasal tissue and secretions during airway remodelling after surgery.

Up-regulation of IL-18 in allergic rhinitis

Background:u2002 This paper reports a study on the concentrations of the pro‐inflammatory cytokines IL‐18 and IL‐1β in nasal secretions of allergic rhinitis patients in relation to ECP and nasal symptoms.

The WHO ARIA (Allergic Rhinitis and Its Impact on Asthma) Initiative

The ARIA working group, in collaboration with the WHO in Geneva, recently published a state-of-the-art review and recommendations derived from it on the link between rhinitis and asthma. Rhinitis is the most frequent manifestation of allergic disease in humans and is often linked to other atopic diseases such as food allergy, atopic dermatitis or asthma, and may furthermore have an impact on the sinuses. ARIA focuses on one of the most important of the mentioned issues, the link between upper and lower airways in allergic disease. To facilitate understanding between the otorhinolaryngologist and the pulmonologist, the classification of rhinitis has been adapted to that of asthma, and the terms intermittent and persistent allergic rhinitis have been introduced. Elaborate guidelines for the diagnosis and assessment of the severity of disease are provided, and detailed recommendations for the management of rhinitis and asthma are suggested with a special focus on specific immunotherapy.

Efficacy of desloratadine in intermittent allergic rhinitis: a GA2LEN study

Background:u2002 The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines proposed a classification for allergic rhinitis based on the duration of symptoms (intermittent, persistent) rather than on the time of allergen exposure (seasonal, perennial). There is no placebo‐controlled, randomized clinical trial on intermittent allergic rhinitis (IAR) to date. Desloratadine (DL) is recommended for the first‐line treatment of seasonal and perennial allergic rhinitis.