The effects of natural pollen exposure on inflammatory cytokines and their relationship with nonspecific bronchial hyperresponsiveness in seasonal allergic rhinitis

Allergy and Asthma Proceedings, Volume 31, Number 2, March/April 2010 , pp. 126-131(6)

Authors: Kurt, Emel¹; Aktas, Ayse; Gulbas, Zafer; Erginel, Sinan; Arslan, Sertac

Publisher: OceanSide Publications, Inc

Abstract:
The exact mechanism of bronchial hyperresponsiveness (BHR) is not clear in allergic rhinitis (AR); an increase of BHR in pollen season suggests that natural pollen exposure causes airway inflammation in seasonal AR (SAR). 

This study was designed to investigate the effects of natural pollen exposure on inflammatory cytokines and their relationship with BHR. 

Sixty-six SAR patients with grass pollen sensitivity and 26 nonallergic rhinitis (NAR) patients were included. Peripheral blood samples for cytokine levels were taken and a nonspecific bronchial provocation test was performed during pollen season between May and August. The same measurements were repeated off-season between November and February. These measurements were done in NAR patients once. During the pollen season, SAR patients had significantly more increased levels of IL-13 than NAR patients (11.45 ± 12.54 versus 5.19 ± 4.02; p = 0.005). Blood eosinophil numbers were higher in those patients with BHR during pollen season than those without BHR (399.0 ± 255.8 versus 278.9 ± 193.2 mm⁻³; p = 0.046). Blood eosinophil numbers during off-season were not different in those with and without BHR (respectively, 261.4 ± 202.3 mm⁻³ versus 205.9 ± 116.9 mm⁻³; p = 0.53). IL-10 levels were higher in the patients without BHR (n = 28) than those patients with BHR (n = 22) during off-season (8.12 ± 13.1 versus 3.28 ± 0.37; p = 0.04). Having higher levels of IL-10 than threshold value was more frequent in SAR patients without BHR than those patients with BHR during off-season (7/28 versus 1/22; χ² = 4.34; p = 0.04). IL-10 has a role in the continuation of BHR during off-season in SAR patients.

Document Type: Research article
DOI: 10.2500/aap.2010.31.3325
Affiliations: 1: Department of Allergy, Faculty of Medicine, Eskisehir Osmangazi University, Turkey. dremelkurt@yahoo.com

Comprehensive review of olopatadine: The molecule and its clinical entities

Allergy and Asthma Proceedings, Volume 31, Number 2, March/April 2010 , pp. 112-119(8) Kaliner, Michael A.¹; Oppenheimer, John; Farrar, Judith R.


Abstract:
Olopatadine is a tricyclic compound with antihistaminic, mast cell-stabilizing, and anti-inflammatory properties. 

In the United States olopatadine is approved as a b.i.d. ophthalmic solution, Patanol (Alcon Laboratories, Inc., Fort Worth, TX) to treat all signs and symptoms of allergic conjunctivitis and as a q.d. formulation, Pataday (Alcon Laboratories, Inc.), to treat itching associated with allergic conjunctivitis. A nasal spray, Patanase (Alcon Laboratories, Inc.), was approved in 2008 for treatment of the symptoms of seasonal allergic rhinitis. 

 

The available data on olopatadine was assessed with regard to future uses through a comprehensive literature review and a Roundtable Discussion held at the 2009 meeting of the American Academy of Allergy Asthma and Immunology. 

 

The unique mechanisms of action of olopatadine still under study include mast cell stabilization, potent H₁-anthistaminic activity, and anti-inflammatory effects. 

 

Data support consideration of nasal olopatadine for as-needed use for episodic symptoms of allergic rhinitis, for treatment of nonallergic rhinitis, and for use in combination with topical steroids for patients with moderate-to-severe allergy symptoms. 

 

Document Type: Research article
DOI: 10.2500/aap.2010.31.3317
Affiliations: 1: Institute for Asthma and Allergy, Chevy Chase, Maryland, USA. makaliner@aol.com

Effects of type II thyroplasty on adductor spasmodic dysphonia.

Otolaryngol Head Neck Surg. 2010 Apr;142(4):540-6.

Sanuki T, Yumoto E, Minoda R, Kodama N.

Graduate School of Medicine, Kumamoto University, Department of Otolaryngology Head & Neck Surgery, Kumamoto, Japan. otostl0319@fc.kuh.kumamoto-u.ac.jp

Abstract

OBJECTIVES: Type II thyroplasty, or laryngeal framework surgery, is based on the hypothesis that the effect of adductor spasmodic dysphonia (AdSD) on the voice is due to excessively tight closure of the glottis, hampering phonation. Most of the previous, partially effective treatments have aimed to relieve this tight closure, including recurrent laryngeal nerve section or avulsion, extirpation of the adductor muscle, and botulinum toxin injection, which is currently the most popular. The aim of this study was to assess the effects of type II thyroplasty on aerodynamic and acoustic findings in patients with AdSD.

STUDY DESIGN: Case series.

SETTING: University hospital.

SUBJECTS AND METHODS: Ten patients with AdSD underwent type II thyroplasty between August 2006 and December 2008. Aerodynamic and acoustic analyses were performed prior to and six months after surgery. Mean flow rates (MFRs) and voice efficiency were evaluated with a phonation analyzer. Jitter, shimmer, the harmonics-to-noise ratio (HNR), standard deviation of the fundamental frequency (SDF0), and degree of voice breaks (DVB) were measured from each subject's longest sustained phonation sample of the vowel /a/.

RESULTS: Voice efficiency improved significantly after surgery. No significant difference was found in the MFRs between before and after surgery. Jitter, shimmer, HNR, SDF0, and DVB improved significantly after surgery.

CONCLUSIONS: Treatment of AdSD with type II thyroplasty significantly improved aerodynamic and acoustic findings. The results of this study suggest that type II thyroplasty provides relief from voice strangulation in patients with AdSD.

Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.

PMID: 20304275 [PubMed - indexed for MEDLINE]

Sutureless tympanoplasty using acellular dermis.

Am J Otolaryngol. 2010 Apr 12.

Raj A, Sayal A, Rathore PK, Meher R.

Department of Otolaryngology and Head, Neck Surgery, MAM College and Assoc. LN Hospital, New Delhi, India.

Abstract

OBJECTIVE: A prospective randomized unblinded controlled trial was conducted by comparing acellular dermis with temporalis fascia as graft materials in tympanoplasty (type 1) in terms of operative time, postoperative pain, graft success rate, and audiologic outcome.

STUDY DESIGN: Forty-two patients with (inactive) chronic suppurative otitis media of tubotympanic type were randomized, matched, and divided equally into 2 groups of 21 each. One group underwent tympanoplasty (type 1) via transcanal route using temporalis fascia graft and the other using acellular dermis. Both groups were compared for operative time, postoperative pain, graft success rate, and audiologic improvement in hearing.

RESULTS: There was a statistically significant reduction in operative time (P < .05) and postoperative pain (P < .05) in the acellular dermis group. However, there was no statistical difference in graft success rate (P > .05) and hearing improvement (P > .05) between both the groups.

CONCLUSION: Results of tympanoplasty using acellular dermis as graft material are comparable to that using temporalis fascia in terms of graft uptake and hearing improvement. However, tympanoplasty using acellular dermis has the advantage of shorter operative time and lesser postoperative pain. Copyright © 2010 Elsevier Inc. All rights reserved.

Impact on hearing of routine ear suctioning at the tympanic membrane.

Am J Otolaryngol. 2010 Apr 12. [Epub ahead of print]

Nelson JJ, Giraud A, Walsh R, Mortelliti AJ.

Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, NY, USA.

Abstract

OBJECTIVE: Patient and equipment safety has become increasingly scrutinized in today's medical care. Routine otolaryngologic evaluation often involves suctioning with Frazier-type suction devices in the ear canal for improved visualization, but data are limited on the potential acoustic trauma from ear canal suction devices. This study intends to document the objective and subjective effects of ear canal suctioning to identify any risk for hearing threshold shifts or other potential negative effects.

PATIENTS AND METHODS: Prospective study on 21 healthy volunteers enlisted for evaluation. Presuctioning tympanogram, audiogram, and otoacoustic emissions data were obtained. Spectrum analyses were recorded during ear canal suctioning with a probe microphone placed lateral to the tympanic membrane. Subjective data were recorded, and a follow-up audiogram and otoacoustic emissions were obtained to identify any temporary threshold shifts.

RESULTS: Spectrum analyses revealed a high degree of variability between subjects. A peak intensity of 111 dB sound pressure level was recorded. All patients tolerated suctioning, and none reported hearing loss. No threshold shifts were observed. Subjective data failed to correlate with the objective recorded intensities.

CONCLUSIONS: Clinicians and patients need to be acutely aware of potential risks and benefits from any medical intervention. Routine ear canal suctioning can be extremely loud and uncomfortable for patients. This study failed to document objective proof of hearing detriment from ear canal suctioning, although the possibility exists during office and surgical intervention. Further study and potential alternative suctioning methods deserve attention.

Copyright © 2010 Elsevier Inc. All rights reserved.

Impact of oseltamivir treatment on the incidence and course of acute otitis media in children with influenza

 

International Journal of Pediatric Otorhinolaryngology (Apr 2010)

 

Winther B, Block SL, Reisinger K, Dutkowski R

OBJECTIVE: Acute otitis media (AOM) is the most common complication of pediatric influenza, and imposes a substantial health care burden. We examined the influence of oseltamivir treatment on the incidence and course of AOM in children with influenza. 

METHODS: In the original study, 695 children 1-12 years who presented within 48h of the onset of influenza-like symptoms were randomized to oseltamivir (2mg/kg) or placebo given twice daily for 5 days. AOM was assessed at enrollment and days 3, 6 (+/-1), 10 (+/-2) and 28 (+/-7). AOM was clinically diagnosed by the participating primary care provider, supported by tympanometry when possible. We performed a retrospective analysis of those participants with laboratory-confirmed influenza (LCI). Assessments included the incidence and clinical course of new AOM cases. 

RESULTS: In all, 452 children had LCI; 217 received oseltamivir and 235 placebo. AOM was diagnosed on or after study day 3 at a significantly lower frequency in the oseltamivir versus placebo group (12.4% versus 21.7%; relative risk [RR]: 0.57 [95% CI: 0.37, 0.88], respectively). Treatment effects were greatest for children 1-2 years (RR=0.42 [95% CI: 0.20, 0.89]) and 3-5 years (RR=0.45 [95% CI: 0.19, 1.04]), in whom the incidence of AOM was highest. 

CONCLUSIONS: Oseltamivir treatment significantly reduces the emergence of new AOM infections in children with LCI; effects are most pronounced in those<5 years. Clinical trial number: WV15758.

Mucocutaneous leishmaniasis masquerading as Wegener granulomatosis

JCR: Journal of Clinical Rheumatology 16 (3), 125-8 (Apr 2010)

 

Brahn E, Pegues DA, Yao Q, Craft N;

 

A 43-year-old Brazilian female presented in 2001 with nasal stuffiness and sinusitis. A biopsy was consistent with limited Wegener's granulomatosis although antineutrophil cytoplasmic antibodies were negative. Her nasal inflammation progressed despite trials of prednisone, methotrexate, and azathioprine. A septal perforation developed and a repeat biopsy showed granulomatous inflammation. In 2006 the patient was referred to Division of Rheumatology, University of California, Los Angeles. 

The nose was grossly erythematous and a magnetic resonance imaging revealed nasal destruction and sinusitis. Palatine biopsies showed chronic inflammation. Cyclophosphamide at 150 mg/d resulted in markedly improved mucocutaneous lesions. The patient developed a leg and arm rash in 2007. A skin biopsy was positive for Leishmania braziliensis. The cyclophosphamide was discontinued and amphotericin B was initiated with transient benefit. Remission was achieved with pentavalent antimony. 

Despite multiple nasopharyngeal biopsies, for a 6-year span, mucocutaneous leishmaniasis masqueraded as Wegener's granulomatosis. Cyclophosphamide not only resulted in clinical improvement, due to reduced inflammatory response, but also allowed widespread cutaneous dissemination.