Diagnostic Value of Nasal Allergen Challenge Combined With Radiography and Ultrasonography in Chronic Maxillary Sinus Disease

Arch Otolaryngol Head Neck Surg. 2009;135(12):1246-1255.Zdenek Pelikan, MD, PhD

Objective To investigate the possible role of nasal allergy in chronic disease of the maxillary sinuses (CDMS) by means of nasal provocation test (NPT) with allergen combined with radiography and ultrasonography.

Design Prospective clinical controlled study.

Setting Academic referral center.

Patients Seventy-one patients with CDMS and 16 control subjects with allergic rhinitis but no history of sinus disease.

Interventions In the 71 patients, a total of 135 NPTs and 71 control challenges with phosphate-buffered saline were performed by rhinomanometry combined with radiography and ultrasonography. In the control patients, 16 positive NPTs were repeated and combined with radiography and ultrasonography.

Main Outcome Measures Number, type, and timing of nasal responses with accompanying changes on radiographs and ultrasonograms.

Results Of the 71 patients, 67 developed 104 positive nasal responses of various types (P < .001), 89 of which were accompanied by significant changes on radiographs (P = .008), whereas 83 were also associated with significant changes on ultrasonograms (P = .007). No significant changes on the radiographs or the ultrasonograms were recorded during the 71 phosphate-buffered saline control tests in the patients with CDMS (P = .14 and .06, respectively) or during the 16 NPTs in control subjects (P = .15 and .12, respectively). The radiographic and ultrasonographic findings were significantly correlated (r = 0.81; P < .01).

Conclusions Nasal allergy may be involved in some patients with CDMS, resulting in appearance of a maxillary sinus response. Monitoring this response by means of serial ultrasonography and, if necessary, also by conventional radiography or computed tomography simultaneously with the nasal challenge with allergen seems to be a very useful diagnostic supplement allowing additional therapeutic measures focused on the nasal allergy.

Minimal persistent inflammation in allergic rhinitis: implications for current treatment strategies

REVIEW ARTICLE

Clinical & Experimental Immunology

Volume 158 Issue 3, Pages 260 - 271

Published Online: 25 Aug 2009
Journal Compilation © 2008 British Society for Immunology

G. W. Canonica and E. Compalati

Allergy and Respiratory Diseases, Clinic Dipartmento di Medicina Interna e Specialita Mediche (DIMI), University of Genova, Genova, Italy

Correspondence to G. W. Canonica, Allergy and Respiratory Diseases, Clinic Dipartmento di Medicina Interna e Specialita Mediche (DIMI), University of Genova, Viale Benedetto XV, no. 6, 16132 Genova, Italy.
E-mail: canonica@unige.it

ABSTRACT

Patients with allergic rhinitis have traditionally been placed into 'seasonal' and 'perennial' categories, which do not account for the subclinical inflammatory state that exists in many patients. In subjects with seasonal and perennial allergic rhinitis, even subthreshold doses of allergen have been found to cause inflammatory cell infiltration in the nasal mucosa, including increases in expression of cellular adhesion molecules, nasal and conjunctival eosinophilia, and other markers of inflammation, which do not result in overt allergy symptoms. This state – which has been termed 'minimal persistent inflammation'– may contribute to hyperreactivity and increased susceptibility to development of clinical symptoms as well as common co-morbidities of allergic rhinitis, such as asthma. Treating overt allergy symptoms as well as this underlying inflammatory state requires agents that have well-established clinical efficacy, convenient administration, potent anti-inflammatory effects and proven long-term safety, so that long-term continuous administration is feasible.

Of the three major classes of commonly used allergic rhinitis medications – intranasal corticosteroids, anti-histamines, and anti-leukotrienes – intranasal corticosteroids appear to represent the most reasonable therapeutic option in patients who would benefit from continuous inhibition of persistent inflammation.

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Accepted for publication 14 August 2009