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• W1985694711 abstract "The purpose of this review is to highlight important articles on upper airway diseases and immunotherapy that appeared during 2006. Studies from Europe continue to examine the usefulness of the Allergic Rhinitis and its Impact on Asthma classification of allergic rhinitis as intermittent or persistent and its levels of severity as mild or moderate/severe. A number of physical agents were shown to effect nasal inflammation: sudden temperature changes in patients with allergic rhinitis increased eosinophilic inflammation; in children with allergic asthma, the personal exposure to particles <2.5 μm air pollution correlated with percent of nasal eosinophils and levels of markers of nasal exudation; and in patients who developed rhinorrhea on exposure to cold and windy weather, nasal challenge with cold dry air caused sloughing of nasal epithelial cells. A 3-month double-blind, placebo-controlled study of nasal washes with amphoteracin B showed no benefit in patients with chronic rhinosinusitis. Studies of immunotherapy with grass and dog dander extracts confirmed the need for doses containing 15 to 20 μg of the major allergen for optimal effectiveness. The protective effect of immunotherapy on the development of asthma in children with allergic rhinitis was shown to still be present 2 years after completion of a 3-year course of treatment. Injection immunotherapy with a moderate dose of house dust mite extract in house dust–sensitive adults with atopic dermatitis reduced symptoms and use of corticosteroids and antihistamines compared with treatment with about 1/1000 of that dose of the same extract. Pretreatment for 9 weeks with the monoclonal anti-IgE antibody omalizumab reduced systemic reactions during rush immunotherapy 5-fold and allowed further build-up at weekly intervals without systemic reactions. A review of sublingual immunotherapy confirmed both efficacy and safety, but evidence for appropriate dosing and for the effectiveness of sublingual immunotherapy employing multiple allergen mixes was still lacking. Two studies with a sublingual grass pollen extract tablet showed a clear dose response and the ability to initiate sublingual immunotherapy without an up-dosing phase. A pilot study with cytosine phosphorothionate quanosine DNA conjugated to the major allergen of ragweed reported impressive improvement in symptoms the first pollen season that persisted during the second pollen season without any further administration of the conjugate. In conclusion, studies on rhinitis and sinusitis explored the pathophysiology of the disease more than offering new therapeutic approaches. Studies on immunotherapy addressed optimal dosing, but also a variety of safer and more convenient approaches such as reduction of IgE with omalizumab, conjugating allergen to immunostimulatory DNA sequences, or administration by the sublingual route. The purpose of this review is to highlight important articles on upper airway diseases and immunotherapy that appeared during 2006. Studies from Europe continue to examine the usefulness of the Allergic Rhinitis and its Impact on Asthma classification of allergic rhinitis as intermittent or persistent and its levels of severity as mild or moderate/severe. A number of physical agents were shown to effect nasal inflammation: sudden temperature changes in patients with allergic rhinitis increased eosinophilic inflammation; in children with allergic asthma, the personal exposure to particles <2.5 μm air pollution correlated with percent of nasal eosinophils and levels of markers of nasal exudation; and in patients who developed rhinorrhea on exposure to cold and windy weather, nasal challenge with cold dry air caused sloughing of nasal epithelial cells. A 3-month double-blind, placebo-controlled study of nasal washes with amphoteracin B showed no benefit in patients with chronic rhinosinusitis. Studies of immunotherapy with grass and dog dander extracts confirmed the need for doses containing 15 to 20 μg of the major allergen for optimal effectiveness. The protective effect of immunotherapy on the development of asthma in children with allergic rhinitis was shown to still be present 2 years after completion of a 3-year course of treatment. Injection immunotherapy with a moderate dose of house dust mite extract in house dust–sensitive adults with atopic dermatitis reduced symptoms and use of corticosteroids and antihistamines compared with treatment with about 1/1000 of that dose of the same extract. Pretreatment for 9 weeks with the monoclonal anti-IgE antibody omalizumab reduced systemic reactions during rush immunotherapy 5-fold and allowed further build-up at weekly intervals without systemic reactions. A review of sublingual immunotherapy confirmed both efficacy and safety, but evidence for appropriate dosing and for the effectiveness of sublingual immunotherapy employing multiple allergen mixes was still lacking. Two studies with a sublingual grass pollen extract tablet showed a clear dose response and the ability to initiate sublingual immunotherapy without an up-dosing phase. A pilot study with cytosine phosphorothionate quanosine DNA conjugated to the major allergen of ragweed reported impressive improvement in symptoms the first pollen season that persisted during the second pollen season without any further administration of the conjugate. In conclusion, studies on rhinitis and sinusitis explored the pathophysiology of the disease more than offering new therapeutic approaches. Studies on immunotherapy addressed optimal dosing, but also a variety of safer and more convenient approaches such as reduction of IgE with omalizumab, conjugating allergen to immunostimulatory DNA sequences, or administration by the sublingual route. This article continues a series of annual reviews of articles published in the Journal and elsewhere that deal with upper airway diseases and allergen immunotherapy.1Nelson H.S. Advances in upper airway diseases and allergen immunotherapy.J Allergy Clin Immunol. 2004; 113: 635-643Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 2Nelson H.S. Advances in upper airway diseases and allergen immunotherapy.J Allergy Clin Immunol. 2005; 115: 676-684Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 3Nelson H.S. Advances in upper airway diseases and allergen immunotherapy.J Allergy Clin Immunol. 2006; 117: 1047-1053Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar Key advances in upper airway diseases are listed in Table I.Table IKey advances in upper airway diseases in 20061. The published literature on the therapeutic efficacy of complementary-alternative treatments for allergic rhinitis and asthma was reviewed, and this treatment was found not to be supported by concurrently available evidence.8Passalacqua G. Bousquet P.J. Carlsen K.-H. Kemp J. Lockey R.F. Niggemann B. et al.ARIA update, I: systematic review of complementary and alternative medicine for rhinitis and asthma.J Allergy Clin Immunol. 2006; 117: 1054-1062Abstract Full Text Full Text PDF PubMed Scopus (143) Google Scholar2. Sudden temperature changes in patients with allergic rhinitis can increase eosinophilic inflammation in the nose.10Graudenz G.S. Landgraf R.G. Jancar S. Tribess A. Fonseca S.G. Fae K.C. et al.The role of allergic rhinitis in nasal responses to sudden temperature changes.J Allergy Clin Immunol. 2006; 118: 1126-1132Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar3. In children with allergic asthma, the personal exposure to PM2.5 air pollution correlated with nasal eosinophils and markers of nasal exudation.12Nikasinovic L. Just J. Sahraoui F. Seta N. Grimfeld A. Momas I. Nasal inflammation and personal exposure to fine particles PM2.5 in asthmatic children.J Allergy Clin Immunol. 2006; 117: 1382-1388Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar4. In patients who develop rhinorrhea on exposure to cold and windy weather, nasal challenge with cold dry air caused sloughing of nasal epithelial cells.11Cruz A.A. Naclerio R.M. Proud D. Togias A. Epithelial shedding is associated with nasal reactions to cold, dry air.J Allergy Clin Immunol. 2006; 117: 1351-1358Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar5. Studies in mice and human beings suggest an important role for nerve growth factor, dendritic cells, and IL-13 in allergic rhinitis, whereas IL-15 may have a suppressive effect.14Wu X. Myers A.C. Goldstone A.C. Togias A. Sanico A.M. Localization of nerve growth factor and its receptors in the human nasal mucosa.J Allergy Clin Immunol. 2006; 118: 428-433Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar6. A 3-month double-blind, placebo-controlled study of nasal washes with amphoteracin B showed no benefit in patients with chronic rhinosinusitis.22Ebbens F.A. Scadding G.K. Badia L. Hellings P.W. Jonssen M. Mullol J. et al.Amphotericin B nasal lavages: not a solution for patients suffering from chronic rhinosinusitis.J Allergy Clin Immunol. 2006; 118: 1149-1156Abstract Full Text Full Text PDF PubMed Scopus (169) Google Scholar7. Improvement of nasal polyps with prednisone treatment was documented in a double-blind, placebo-controlled study.25Hissaria P. Smith W. Wormald P.J. Taylor J. Vadas M. Gillis D. et al.Short course of systemic corticosteroids in sinonasal polyposis: a double-blind randomized, placebo-controlled trail with evaluation of outcome measures.J Allergy Clin Immunol. 2006; 118: 128-133Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar8. Nasal polyps responded to a monoclonal anti–IL-5 antibody only in subjects with elevated levels of IL-5 in their nasal secretions.26Gevaert P. Lang-Loidolt D. Lackner A. Stammberger H. Staudinger H. Van Zele T. et al.Nasal interleukin-5 levels determine the response to anti-interleukin-5 treatment in nasal polyp patients.J Allergy Clin Immunol. 2006; 118: 1133-1141Abstract Full Text Full Text PDF PubMed Scopus (335) Google Scholar9. Decreased EP2 receptors were found on nasal inflammatory cells in biopsies of aspirin-sensitive compared with nonaspirin-sensitive patients with rhinitis.27Ying S. Meng Q. Scadding G. Parikh A. Corrigan C.J. Lee T.H. Aspirin-sensitive rhinosinusitis is associated with reduced E-prostanoid 2 receptor expression on nasal mucosal inflammatory cells.J Allergy Clin Immunol. 2006; 117: 312-318Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar Open table in a new tab The Allergic Rhinitis and its Impact on Asthma (ARIA) recommendations included a proposed new classification for allergic rhinitis. Rather than seasonal or perennial, it was suggested that, similar to asthma, rhinitis be classified as intermittent or persistent, and the severity classified as mild or moderate/severe. A study was conducted with 302 patients consulting general practitioners in France for allergic rhinitis to assess the impairment incurred by patients in the different ARIA categories of allergic rhinitis.4Bousquet J. Neukirch F. Bousquet P.J. Gehano P. Klossek J.M. Le Gal M. et al.Severity and impairment of allergic rhinitis in patients consulting in primary care.J Allergy Clin Immunol. 2006; 117: 158-162Abstract Full Text Full Text PDF PubMed Scopus (237) Google Scholar Nearly equal numbers of subjects had intermittent and persistent rhinitis. However, when severity was judged by rhinitis-specific quality of life, quality of sleep, and work performance, it was found that approximately 90% of these patients with allergic rhinitis consulting general practitioners had moderate/severe symptoms that were impairing daily activities, sleep, and work. The ARIA classification was also tested in 804 patients enrolled by Belgian general practitioners during the pollen season.5Van Hoecke H. Vastesaeger N. Dewulf L. De Bacquer D.F. van Cauwenberge P. Is the allergic rhinitis and its impact on asthma classification useful in daily primary care practice?.J Allergy Clin Immunol. 2006; 118: 758-759Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar They confirmed that the classification into intermittent and persistent did not correspond to seasonal and perennial. They also found that 98% of their subjects met the criteria for moderate/severe. They therefore suggested new criteria for severity classification. Patients would be asked whether their symptoms of allergic rhinitis caused sleep disturbance and whether they caused impairment of daily personal and/or profession life. Patients would be categorized as mild if they answered no to both, moderate if they had 1 affirmative response, and severe if they responded affirmatively to both questions. Using these criteria, the patients were now divided into 20.5% mild, 45.9% moderate, and 33.6% severe. Using these new criteria for severity, the researchers found for all symptoms except rhinorrhea that there was a linear increasing trend from mild to moderate to severe as well as a significant association with increasing prescription rate of nasal and oral glucocorticosteroids. In a Clinical Pearls article, Dr Richard Lockey6Lockey R.F. Rhinitis medicamentosa and the stuffy nose.J Allergy Clin Immunol. 2006; 118: 1017-1018Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar addressed the problem of rhinitis medicamentosa and the stuffy nose. He pointed out that patients often begin using topical decongestants because of pre-existing chronic nasal obstruction. Therefore, the patients should have a detailed work-up to identify the underlying condition. The exception would be those who begin the intranasal decongestant after a respiratory infection and continue it indefinitely because of the self-induced rebound phenomena. Nasal corticosteroids are the most effective treatment for underlying conditions leading to nasal obstruction. In those patients in whom topical steroids are not sufficient to control obstruction, he recommended that judicious use of topical decongestants together with topical corticosteroids may provide the patient with symptomatic relief. Two reviews of pharmacotherapy for rhinitis were published.7Greiner A.N. Meltzer E.O. Pharmacologic rationale for treating allergic and non-allergic rhinitis.J Allergy Clin Immunol. 2006; 118: 985-996Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar, 8Passalacqua G. Bousquet P.J. Carlsen K.-H. Kemp J. Lockey R.F. Niggemann B. et al.ARIA update, I: systematic review of complementary and alternative medicine for rhinitis and asthma.J Allergy Clin Immunol. 2006; 117: 1054-1062Abstract Full Text Full Text PDF PubMed Scopus (143) Google Scholar The first reviewed the epidemiology and classification of both allergic and nonallergic rhinitis and evidence for the effectiveness of the available treatment, including topical corticosteroids, antihistamines, decongestants, cromolyn, antileukotrienes, ipratropium, omalizumab, and nasal saline irrigation.7Greiner A.N. Meltzer E.O. Pharmacologic rationale for treating allergic and non-allergic rhinitis.J Allergy Clin Immunol. 2006; 118: 985-996Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar The second looked at complementary and alternative medicine.8Passalacqua G. Bousquet P.J. Carlsen K.-H. Kemp J. Lockey R.F. Niggemann B. et al.ARIA update, I: systematic review of complementary and alternative medicine for rhinitis and asthma.J Allergy Clin Immunol. 2006; 117: 1054-1062Abstract Full Text Full Text PDF PubMed Scopus (143) Google Scholar Although randomized, preferably double-blind trials were sought in reviewing the literature, in reality the methodology of the trials with complementary-alternative medicine was frequently inadequate. Meta-analysis provided no clear evidence for efficacy of acupuncture in rhinitis and asthma. Although some trials of homeopathy reported positive results in rhinitis, other studies were negative. Therefore, no evidence-based recommendation for homeopathy in the treatment of allergic rhinitis could be provided. There was a limited number of studies of herbal preparations in rhinitis, some of which reported efficacy. Their number was too few to make any recommendations for treatment. Furthermore, there were concerns regarding the standardization and purity of the herbal preparations. The conclusion was that the therapeutic efficacy of complementary-alternative treatments for rhinitis and asthma is not supported by currently available evidence. More conventional treatment for seasonal allergic rhinitis was discussed in an article on the new nasal corticosteroid ciclesonide.9Ratner P.H. Wingertzahn M.A. van Bavel J.H. Hampel F. Darken P.F. Shah T. Efficacy and safety of ciclesonide nasal spray for the treatment of seasonal allergic rhinitis.J Allergy Clin Immunol. 2006; 118: 1142-1148Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar Ciclesonide nasal spray demonstrated a significant improvement in the total nasal symptoms versus placebo by the second day of treatment. Over the first 2 weeks, symptoms declined by 17% in the placebo groups and 27% in the ciclesonide groups. The response of the nasal mucosa to stimulation with sudden temperature changes; cold, dry air; and fine particulate air pollution was reported this year in the Journal.10Graudenz G.S. Landgraf R.G. Jancar S. Tribess A. Fonseca S.G. Fae K.C. et al.The role of allergic rhinitis in nasal responses to sudden temperature changes.J Allergy Clin Immunol. 2006; 118: 1126-1132Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar, 11Cruz A.A. Naclerio R.M. Proud D. Togias A. Epithelial shedding is associated with nasal reactions to cold, dry air.J Allergy Clin Immunol. 2006; 117: 1351-1358Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar, 12Nikasinovic L. Just J. Sahraoui F. Seta N. Grimfeld A. Momas I. Nasal inflammation and personal exposure to fine particles PM2.5 in asthmatic children.J Allergy Clin Immunol. 2006; 117: 1382-1388Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar The effects of experimental air conditioning–like temperature changes on the nasal mucosa of individuals with persistent allergic rhinitis were examined.10Graudenz G.S. Landgraf R.G. Jancar S. Tribess A. Fonseca S.G. Fae K.C. et al.The role of allergic rhinitis in nasal responses to sudden temperature changes.J Allergy Clin Immunol. 2006; 118: 1126-1132Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar Sudden temperature changes in the patients with rhinitis led to a significant increase in symptoms, total cells, percent of eosinophils, and epithelial shedding as well as albumin in nasal secretions compared with baseline. Ten subjects who reported rhinorrhea with cold and windy weather, 6 of whom had allergic rhinitis, received nasal challenges with cold, dry air and with warm, moist air.11Cruz A.A. Naclerio R.M. Proud D. Togias A. Epithelial shedding is associated with nasal reactions to cold, dry air.J Allergy Clin Immunol. 2006; 117: 1351-1358Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar A 6-fold increase in sloughed nasal epithelial cells followed cold, dry air but not warm, moist air challenge. No similar increase in sloughing of nasal epithelial cells was observed after cold, dry air challenge in subjects not reporting symptoms on exposure to cold or windy weather. It was concluded that the nasal mucosa of individuals sensitive to cold dry air cannot compensate for the water loss that occurs under extreme conditions, leading to epithelial damage. Forty-one children in Paris with asthma and 44 healthy children were monitored for 48 hours for their personal exposure to particles 2.5 μm or less in diameter (PM2.5).12Nikasinovic L. Just J. Sahraoui F. Seta N. Grimfeld A. Momas I. Nasal inflammation and personal exposure to fine particles PM2.5 in asthmatic children.J Allergy Clin Immunol. 2006; 117: 1382-1388Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar At the end of the measurement period, subjects underwent nasal lavage. In the children with asthma but not in the healthy children, personal PM2.5 levels were correlated with nasal percentage eosinophils and with markers of nasal exudation. The study demonstrated the association between exposure to fine particulate air pollution and nasal inflammation in children with allergic asthma in an urban area. The role of the nervous system in rhinitis was reviewed.13Sarin S. Undem B. Sanico A. Togias A. The role of the nervous system in rhinitis.J Allergy Clin Immunol. 2006; 118: 999-1014Abstract Full Text Full Text PDF PubMed Scopus (159) Google Scholar Sensory nerves transmit signals from the mucosa, generating sensations such as pruritus, motor reflexes such as sneezing, and parasympathetic and sympathetic reflexes that affect the glandular and vascular nasal apparatuses. Reflexes affecting nasal symptoms also arise from other body regions, and reflexes arising in the nose can affect the lower airway. Nasal hyperresponsiveness can arise as a result of inflammatory products such as neurotropins, among which is the nerve growth factor. Nasal tissue samples from patients undergoing partial turbinectomy for nasal obstruction were examined for nerve growth factor (NGF) and nerve growth factor receptors.14Wu X. Myers A.C. Goldstone A.C. Togias A. Sanico A.M. Localization of nerve growth factor and its receptors in the human nasal mucosa.J Allergy Clin Immunol. 2006; 118: 428-433Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar NGF was localized to activated eosinophils and submucosal glands and less to epithelial lining. NGF receptors were localized not only on nerves but also on nasal epithelium, submucosal glands, and some interstitial cells. It was concluded that the distribution of NGF and its receptors and its established release during allergic reactions suggest that this factor participates in the pathophysiology of allergic rhinitis. The role of dendritic cells in allergic rhinitis was examined in both human beings and mice.15KleinJan A. Willart M. van Rijt L.S. Braundstahl G.-J. Leman K. Jung S. et al.An essential role for dendritic cells in human and experimental allergic rhinitis.J Allergy Clin Immunol. 2006; 118: 1117-1125Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar In nasal mucosal biopsies from symptomatic patients with perennial rhinitis, the number of dendritic cells in the epithelium and lamina propria was increased compared with healthy controls. Furthermore, they were found in proximity to T lymphocytes. Similarly, in a mouse model of allergic rhinitis, dendritic cells were found clustered with CD4+ lymphocytes. When the dendritic cells were depleted, nasal challenge in the sensitized mice did not induce nasal eosinophilia, boost specific IgE levels, or increase TH2-type cytokine production. However, when allergen-pulsed dendritic cells were administered intranasally to sensitized mice, nasal eosinophilia and TH2 cytokine production were enhanced. The authors concluded that dendritic cells in the nose play an essential role in the activation of TH2 lymphocytes, leading to allergic rhinitis. A similar model of murine allergic rhinitis was used to explore the possible role of IL-15 in the allergic response.16Aoi N. Musuda T. Murakkami D. Yajima T. Mizubuchi H. Yamada H. et al.IL-15 prevents allergic rhinitis through reactivation of antigen-specific CD8+ cells.J Allergy Clin Immunol. 2006; 117: 1359-1366Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar IL-15 knockout mice responded to nasal allergen challenge with increased sneezing, infiltration of eosinophils, and TH2 cytokine production compared with controls. Adoptive transfer of CD8+ T cells from sensitized mice to control mice suppressed the TH2 responses but was ineffective in IL-15 knockout mice. However, the administration of IL-15 at the time of nasal allergen challenge prevented the development of allergic rhinitis in sensitized mice. It was concluded that IL-15 plays an important role in suppression of allergic rhinitis, probably through activation of memory CD8+ T cells that downregulate the TH2 response to allergen. The contribution of IL-13 to the early and late nasal response to allergen challenge in sensitized mice was explored by using IL-13 knockout mice and a fusion protein of the IL-13 receptor and the Fc portion of human IgG, which binds to and neutralizes IL-13.17Miyahara S. Miyahara N. Matsubara S. Takeda K. Koya T. Gelfand E.W. IL-13 is essential to the late phase response in allergic rhinitis.J Allergy Clin Immunol. 2006; 118: 1110-1116Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar The early response to nasal allergen challenge was little affected. On the other hand, the late response, measured by nasal obstruction at 24 hours postchallenge, was markedly reduced. The reduction in the late nasal response did not appear to be dependent on reduction in the infiltration with eosinophils. The results suggested to the authors that blockage of IL-13 may have therapeutic application to reduce nasal obstruction in allergic rhinitis. Because of epidemiologic data showing a frequent association between allergic rhinitis and asthma, the relationship between allergic rhinitis and pathologic changes in the lower airway was reviewed.18Ciprandi G. Cirillo I. The lower airway pathology of rhinitis.J Allergy Clin Immunol. 2006; 118: 1105-1109Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar Two groups of patients with only rhinitis symptoms, one seasonal and the other perennial, underwent spirometry and methacholine challenge. Asymptomatic lower airway abnormalities were found in both groups. In the 100 patients with perennial rhinitis, 5 had an abnormal FEV1, 25 an abnormal FEF25-75, and 72 a positive methacholine challenge. Two studies were performed in patients with both allergic rhinitis and asthma. A highly significant correlation was observed between nasal eosinophils (r = .91) and nasal airflow (r = .89) on the one hand and the FEV1 as a percent predicted. On the basis of their review, the authors recommend that patients with allergic rhinitis should be evaluated to detect possible bronchial involvement. A well-recognized consequence of the allergic reaction in the nose, induced by both allergen challenge and natural exposure, is the phenomenon of nasal priming. After allergen exposure, there is a lowering of the nasal threshold to subsequent allergen exposure that is not allergen-specific. This phenomenon was carefully investigated and described by Dr John Connell.19Dworetzky M. John T. Connell.J Allergy Clin Immunol. 2006; 118: 1192-1194Abstract Full Text Full Text PDF Google Scholar, 20Sahin-Yilmaz A.A. Naclerio R.M. Nasal priming.J Allergy Clin Immunol. 2006; 118: 1190-1192Abstract Full Text Full Text PDF Google Scholar His work and subsequent studies of nasal priming are discussed in the Allergy Archives in the November 2006 issue of the Journal. A most unusual consequence of allergic rhinitis was described in a 33-year-old man hospitalized for sudden hearing loss; the only associated problem was seasonal allergic rhinitis.21Lombardi C. Tansini A. Passalacqua G. Seasonal sensorineural hearing loss associated with allergic rhinitis: a case report.J Allergy Clin Immunol. 2006; 117: 468-469Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar The hearing problem cleared rapidly on systemic steroids but recurred during the same spring pollen season the next 10 years. At the time he was symptomatic, magnetic resonance imaging revealed an inflammatory edema of the acoustic nerves bilaterally. The symptoms did not occur the following season when rhinitis symptoms were controlled with nasal steroids and an antihistamine. The debate over the role of antifungal therapy for chronic rhinosinusitis that was reported in last year's Advances3Nelson H.S. Advances in upper airway diseases and allergen immunotherapy.J Allergy Clin Immunol. 2006; 117: 1047-1053Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar continues. A study from The Netherlands reported the results of 3 months of treatment of chronic rhinosinusitis with twice-daily amphoteracin B or placebo nasal washes in 116 randomly assigned patients.22Ebbens F.A. Scadding G.K. Badia L. Hellings P.W. Jonssen M. Mullol J. et al.Amphotericin B nasal lavages: not a solution for patients suffering from chronic rhinosinusitis.J Allergy Clin Immunol. 2006; 118: 1149-1156Abstract Full Text Full Text PDF PubMed Scopus (169) Google Scholar Ninety-nine subjects completed the study. There were no differences either before or after 13 weeks of treatment between the 2 groups for nasal symptoms, quality of life, peak nasal inspiratory flow values, nasal endoscopy scores, or polyp scores. Radiologic assessment of the sinuses was not performed. The authors concluded that amphotericin B nasal lavages, as administered in this study, are ineffective and therefore not advised in the treatment of patents with chronic rhinosinusitis. In 2004 a distinguished panel consisting predominantly of allergist/immunologists and otorhinolaryngologists developed a report entitled, “Rhinosinusitis: Establishing definitions for clinical research and patient care,” that appeared in the Journal.23Meltzer E.O. Hamilos D.L. Hadley J.A. Lanza D.C. Marple B.F. Nicklas R.A. et al.Rhinosinusitis: establishing definitions for clinical research and patient care.J Allergy Clin Immunol. 2004; 114: 155-212Abstract Full Text Full Text PDF PubMed Scopus (629) Google Scholar In the Journal this year, a follow-up panel report appeared entitled, “Rhinosinusitis: Developing guidance for clinical trials.”24Meltzer E.O. Hamilos D.L. Hadley J.A. Lanza D.C. Marple B.F. Nicklas R.A. Rhinosinusitis: developing guidance for clinical trials.J Allerg" @default.
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