WASHINGTON, DC—Rhinitis—inflammation of the nasal mucosa—has two main types: allergic (IgE-mediated) and nonallergic; together, they affect more than 50 million Americans. Both types diminish quality of life, result in about 20 million physician visits each year, and cost billions of dollars. Robert M. Naclerio, MD, Professor of Surgery and Section Chief of Otolaryngology Head and Neck Surgery at the University of Chicago, and two of his colleagues at that institution, Fuad M. Baroody, MD, and Jayant M. Pinto, MD, discussed new developments in the management of rhinitis.
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December 2007Seasonal Allergic Rhinitis
Assessing the severity of seasonal allergic rhinitis (SAR), contrary to what one would intuit, is related more to quality-of-life factors than to physiological ones, said Dr. Naclerio. For example, sufferers performed worse on cognitive tests and exhibited sometimes dangerous daytime sleepiness because SAR affects their ability to sleep at night.
One also might think that avoidance of allergens would alleviate most of the symptoms, but that too is wrong, he added. “Although the studies we have are poor, we do know, for instance, that reducing dust mites, by current recommendations, has little effect on the clinical impact of dust mite-induced rhinitis. In fact, not many environmental factors appear to have much of an effect—except stopping smoking and reducing exposure to secondhand smoke.” Both alter dendritic cell function, increase respiratory symptoms, and decrease the effect of inhaled corticosteroids when they are used.
Avoidance issues are especially pertinent for children whose allergic parents are often unduly worried about their children developing allergies. SAR can be delayed with avoidance to allergens, but it will show up eventually. “What you buy in the short run, you lose in the long run,” Dr. Naclerio said. “Smoking is the one thing parents can control and they should stop it. A number of studies support this recommendation.”
Dr. Pinto told the audience that people with SAR and asthma have a reduced ability to condition air. “Because these individuals have inflammation in the nose, we hypothesized that treatment with an intranasal steroid would reduce nasal inflammation and decrease nasal conditioning capacity.”
Therefore, Dr. Pinto and his colleagues performed a randomized, double-blind, placebo-controlled study on 20 people with asthma to compare the effect of treatment with intranasal budesonide (Rhinocort) on nasal conditioning for two weeks. The drug reduced inflammation in the nonsmokers, but had no effect in the smokers. In the subgroup of nonsmokers who had a significant reduction in inflammation, the nasal conditioning was also reduced, as predicted.