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Purpose: The primary aim of this systematic review is to assess the efficacy, safety, and cost-effectiveness of high-volume steroid nasal irrigation (SNI) for treating chronic rhinosinusitis (CRS) and allergic rhinitis (AR). Methods: A systematic review of literature from 2012 to 2024 was conducted using PubMed to identify relevant studies. The search focused on terms related to AR, CRS, and steroid nasal irrigation. Studies were screened for relevance and duplicates removed, resulting in 20 studies being included in the final analysis. These studies were categorized based on their focus on efficacy, safety, or both, and underwent a risk of bias assessment using Cochrane and ROBINS-I tools. Results: Of the 20 studies included, 13 examined the effectiveness of high-volume nasal steroid irrigations, 4 investigated safety, and 3 covered both. High-volume irrigations demonstrated superior efficacy in symptom improvement for CRS and AR compared to nasal sprays, particularly post-surgery. Budesonide was the most commonly used steroid. Safety evaluations indicated no significant hypothalamic–pituitary–adrenal axis suppression or increases in intraocular pressure, although minor adverse events were reported. Conclusion: High-volume steroid nasal irrigations are more effective than standard nasal sprays for CRS and AR, particularly post-surgery, without significant safety concerns. However, no studies on cost-effectiveness were found, suggesting a need for further research in this area. [ABSTRACT FROM AUTHOR]

Background: Because long‐term effectiveness of pollen allergen immune therapy (AIT) for allergic rhinitis (AR) is not well‐described, we studied effectiveness over 18 years in Denmark. Methods: A register‐based cohort study using data on filled prescriptions, 1995–2016, Denmark. In a cohort of 1.1 million intranasal corticosteroid inhaler users (proxy for AR), we matched users treated with grass, birch or mugwort AIT 1:2 with non‐treated users on baseline year and 24 characteristics in the 3 years prior to baseline. The primary outcome was the odds ratio (OR) of using anti‐allergic nasal inhaler during the pollen season in the treated versus non‐treated group by years since baseline. Results: Among 7760 AR patients treated with pollen AIT, the OR of using nasal inhaler 0–5 years after baseline was reduced when compared with 15,520 non‐treated AR individuals (0–2 years, OR 0.84 (0.81–0.88); 3–5 years, OR 0.88 (0.84–0.92)), but was close to unity or higher thereafter (6–9 years, OR 1.03 (0.97–1.08); 10–18 years, OR 1.18 (1.11–1.26)). In post hoc analyses, results were more consistent for those who already had 3 of 3 baseline years of use, and in patients using nasal inhaler in the latest pollen season (0–2 years, OR 0.76 (0.72–0.79); 3–5 years OR 0.86 (0.81–0.93); 6–9 years, OR 0.94 (0.87–1.02); 10–18 years, OR 0.94 (0.86–1.04)) as opposed to no such use. Conclusions: Patients treated with pollen AIT in routine care to a higher degree stopped using anti‐allergic nasal inhaler 0–5 years after starting the standard 3 years of therapy, and not beyond 5 years. Post hoc analyses suggested effectiveness was more consistent among patients with persistent AR. [ABSTRACT FROM AUTHOR]

Copyright of Revista Pediatría de Atención Primaria is the property of LUA Ediciones 3.0 S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and purpose: Acute rhinosinusitis is a common condition worldwide, usually caused by respiratory viruses. Nasal epithelium is their primary point of entry and an active responder to the infection. Therefore, it seems reasonable for the treatment approach to include locally applied drugs. Our purpose is to bring forward up-to-date recommendations of intranasal treatment options for acute rhinosinusitis, and assess their efficacy and safety. Description of the state of knowledge: Rhinosinusitis is an inflammation of the mucosa present in the nose and the paranasal sinuses. It affects many patients yearly, bearing significant adverse effects on quality of life, productivity and healthcare expenditure. Acute rhinosinusitis lasts less than 12 weeks and is divided into viral, post-viral and acute bacterial rhinosinusitis. It is one of the prevailing reasons for unfounded antibiotics prescription, although it is usually self-limiting. Its treatment depends on the clinical stage of the infection, however, each of them encloses medications administered intranasally. Based on EPOS2020 and scientific publications it seems that nasal decongestants may be prescribed in viral rhinosinusitis, nasal corticosteroids in post-viral rhinosinusitis and nasal saline can prove beneficial in all clinical stages of rhinosinusitis. While used appropriately all aforementioned medications prove to be safe. Conclusions: In the light of the findings presented in this paper, it can be concluded that acute rhinosinusitis should be treated not only with oral, but also with intranasal drugs. Nasal decongestants are to be considered in viral rhinosinusitis mainly. Nasal corticosteroids show some positive effect in post-viral rhinosinusitis. Nasal saline can be administered in all clinical stages of acute rhinosinusitis. It is crucial to caution the patients against misuse of the medications, in order to prevent their adverse effects.

Background: Mobile health interventions (MHI) offer the potential to help improve nasal corticosteroid (NCS) adherence in allergic rhinitis (AR). The aim of this systematic review was to summarise the current evidence on the effectiveness of MHI for improving NCS adherence in AR. Methods: We systematically searched MEDLINE, Embase and the Cochrane Central register of Controlled Trials (CENTRAL) for randomised controlled trials filtered for publication dates between 2010 and 2021. We evaluated the effects of MHI aiming to improve NCS adherence on self‐management outcomes in AR and comorbid conditions. Two reviewers independently screened potential studies, extracted study characteristics and outcomes from eligible papers and assessed risk of bias using the Cochrane Risk of Bias tool 2.0. High heterogeneity precluded meta‐analysis. Data were descriptively and narratively synthesised. Results: Our searches identified 776 individual studies of which 4 met the inclusion criteria. These studies were heterogeneous with respect to participant, intervention and outcome characteristics. We considered all outcome‐specific overall risk of bias assessments to be of high risk of bias except for two studies examining NCS adherence which received 'some concern' grades. The three studies which reported on NCS adherence found that MHI were associated with improvement in NCS adherence. Significant MHI‐associated improvement in symptoms or disease‐specific quality of life was found in one study each, whilst no study reported significant differences in nasal patency. Conclusions: Whilst MHI showed potential to improve NCS adherence, their effect on clinical outcomes varied. Furthermore, robust studies with longer intervention durations are needed to adequately assess effects of MHI and their individual features on NCS adherence and clinical outcomes. [ABSTRACT FROM AUTHOR]

Sinusitis is a common condition for which patients often consult the community pharmacist. It is, however, challenging to differentiate between common forms of sinusitis as they have nearly identical clinical representations. This review article provides an overview of sinusitis, classification, differential diagnosis between viral sinusitis, bacterial sinusitis and chronic rhinosinusitis, therapeutic management, patient education and patient referral guidelines. In addition, the recently updated guidelines on sinusitis published by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (2015), the European position paper on rhinosinusitis and nasal polyps, EPOS 2012 and the Canadian guidelines for acute bacterial rhinosinusitis (2014) will be reviewed. [ABSTRACT FROM AUTHOR]

The increase of allergic rhinitis incidence is an actual problem for industrial cities. The literature data on allergic rhinitis incidence in countries of Europe andUkrainewas analyzed. According to different authors, the allergic rhinitis is registered in 12-24% of the inhabitants of the Russian Federation, 26-40% - of the USA, 24-32% - of France, 16% – of the UK, and 19% – of Denmark. There were distinguished three main clinical forms of allergic rhinitis: light, moderate and heavy. General pharmacotherapy principles of the light and moderate forms of allergic rhinitis course are presented in the current article. There were indicated medicines for the first-line therapy of allergic rhinitis group "R01AD" - the medicines acting on the respiratory system, decongestants and other drugs for topical use in diseases of the nasal cavity, corticosteroids. The assortment of nasal corticosteroids is presented by mometasone (13 trade names), beclamethasone (2 trade names), fluticasone propionate (5 trade names). It is also shown that 95.6% of the nasal corticosteroids is imported from 9 countries, mainly fromIndiaandBelgium. The Ukrainian spray Forinex produced by Pharmac is the only representative among the R01AD group, but unfortunately, according to pricing range is not a drug of choice among nasal corticosteroids. The received data testify to the risk of inclusion of only imported drugs in the insurance list and the low replacement rate by the Ukrainian drug for treatment of the allergic rhinitis.

Background: The current study describes the spectrum of community‐acquired respiratory infections (CARV) during the first year after lung transplantation (LT). Additionally, we elucidate variables associated with CARV, management strategies utilized, and impact on early and late outcomes. Methods: This was a retrospective study among patients transplanted between 2012 and 2015 (n = 255, mean age 55.6 ± 13.5 years, M: F 152:103). The diagnosis of CARV was based on the multiplex PCR on nasopharyngeal swab samples. Baseline characteristics, post‐transplant variables, and outcomes were compared among patients with and without CARV. Results: Eighty CARV infections developed among a quarter of the study group (n = 62, 24.3%). Rhinovirus/enterovirus was the most commonly isolated CARV (n = 24) followed by coronavirus (n = 17) and RSV (n = 9). A significant proportion of episodes (43.8%) required hospitalization. The use of nasal corticosteroids and left single LT was independently associated with an increased risk of CARV. CARV infections did not impact the lung functions during the first year or the CLAD‐free survival at 3 years. Conclusions: There is a significant burden of CARV infections during the first year after LT. The use of nasal corticosteroids may increase the risk of CARV infection. CARV infections did not impact outcomes. [ABSTRACT FROM AUTHOR]

Les causes de ronflement sont multiples chez l'enfant et peuvent se succéder au cours de la première décade. La rhinite allergique doit être évoquée en cas d'obstruction nasale avec congestion des cornets inférieurs. La preuve est apportée par les prick-tests. Le traitement fait appel à des corticoïdes intra-nasaux et des antihistaminiques oraux. Une désensibilisation orale, lorsqu'elle est possible, est indiquée en cas d'insuffisance du résultat ou si la rhinite est associée à un asthme. Snoring in children may be due to several causes that may succeed one another throughout the first ten years of life. Allergic rhinitis should be considered where there is nasal obstruction with congestion of the inferior turbinates. This diagnosis may be confirmed by prick-tests. Treatment consists of nasal corticosteroids and oral antihistamine. Where possible, oral desensitisation should be proposed if snoring persists or if the rhinitis is associated with asthma. [ABSTRACT FROM AUTHOR]

Purpose of Review: This paper explores how the Environmental Exposure Unit (EEU) experimental model can be used to further our understanding of pharmacotherapies and immunotherapies for the treatment of allergic rhinitis (AR). Recent Findings: EEUs are used increasingly for the study of combination therapies, immunotherapies, and novel AR treatments. A combined antihistamine/corticosteroid nasal spray formulation was seen to have a faster onset of action relative to the therapies individually in the Environmental Exposure Chamber. House dust mite sublingual immunotherapy tablets are both safe and efficacious as evaluated by the Vienna Challenge Chamber. The Kingston EEU found that a novel peptide-based immunotherapy approach to be effective in reducing grass pollen-induced AR. Lastly, nasal filters were determined to reduce seasonal AR symptoms, given out-of-season in the Denmark Environmental Exposure Unit. Summary: EEUs are controlled, replicable models that provide valuable insight into the efficacy, onset and duration of action, and dose-related impacts of AR therapeutics, with direct clinical relevance. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate whether an ethmoidal drug‐eluting stent (DES) (the Relieva Stratus™ MicroFlow Spacer) could better prevent endoscopic sinus surgery (ESS) than standard non‐invasive therapy using corticosteroid nasal spray in patients suffering from chronic rhinosinusitis (CRS). Design: Prospective, randomised clinical trial. Setting: Tertiary referral centre. Participants: Sixty‐three adult patients with ethmoidal involvement in cone beam computerised tomography (CBCT) whose first‐line medical treatment with topical corticosteroids had failed and who were candidates for ESS were randomised either to a DES group, which received triamcinolone acetonide stents (n = 34), or to a topical intranasal corticosteroid group (n = 29) that used optimally dosed triamcinolone acetonide nasal spray. Outcome measures: Patients were followed up prospectively for 6 months and at 36 months. Freedom from ESS was the primary endpoint. Further, we identified those factors predicting ESS. Results: At 6 months, ESS could be prevented in almost half of the patients in both groups (DES 13/28, 46.4%, nasal spray 14/29, 48.3%). At 36 months, 20/28 (71.4%) patients in the DES group and 18/29 (62.1%) in the nasal spray group had been operated. The differences were not statistically significant at either timepoint. Patients who smoked (14/19, 73.7% vs 16/38, 42.1%) were more likely to be operated at 6 months. Conclusion: Endoscopic sinus surgery can be prevented using both therapies in the medium term in almost half of cases with neither therapy being statistically superior. This effect was somewhat diminished in the long term with a trend towards more patients being operated in the DES group. Considering the additional costs, the need for general anaesthesia and the potential side effects associated with DES, its potential clinical role appears to be limited. Smoking was significantly associated with ESS. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease. No medications are Food and Drug Administration-approved for the most common form, CRS without nasal polyps (also called "chronic sinusitis"). Novel biomechanics of the exhalation delivery system deliver fluticasone (EDS-FLU; XHANCE) to sinonasal areas above the inferior turbinate, especially sinus drainage pathways not reached by standard-delivery nasal sprays., Objective: Assess EDS-FLU efficacy for CRS (irrespective of nasal polyps)., Methods: Two randomized, EDS-placebo-controlled trials in adults with CRS irrespective of polyps (ReOpen1) or exclusively without polyps (ReOpen2) were conducted at 120 sites in 13 countries. Patients received EDS-FLU 1 or 2 sprays/nostril, or EDS-placebo, twice daily for 24 weeks. Coprimary measures were composite symptom score through week 4 and ethmoid/maxillary sinus percent opacification by computed tomography at week 24., Results: ReOpen1 (N = 332) composite symptom score least-squares mean change for EDS-FLU 1 or 2 sprays/nostril versus EDS-placebo was -1.58 and -1.60 versus -0.62 (P < .001, P < .001); ReOpen2 (N = 223), -1.54 and -1.74 versus -0.81 (P = .011, P = .001). In ReOpen1, sinus opacification least-squares mean change for EDS-FLU 1 or 2 sprays/nostril versus EDS-placebo was -5.58 and -6.20 versus -1.60 (P = .045, P = .018), and in ReOpen2, -7.00 and -5.14 versus +1.19 (P < .001, P = .009). Acute disease exacerbations were reduced by 56% to 66% with EDS-FLU versus EDS-placebo (P = .001). There were significant, and similar magnitude, symptom reductions in patients using standard-delivery nasal steroid products just before entering the study (P < .001). Adverse events were similar to standard-delivery intranasal steroids., Conclusions: EDS-FLU is the first nonsurgical treatment demonstrated to reduce symptoms, intrasinus opacification, and exacerbations in replicate randomized clinical trials in CRS, regardless of polyp status., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

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Objective: To systematically review the literature on anti-inflammatory medications for treating pediatric obstructive sleep apnea and perform meta-analysis of the available data.Data Sources: PubMed/MEDLINE and 4 additional databases.Review Methods: Three authors independently and systematically searched through June 28, 2018, for studies that assessed anti-inflammatory therapy for treatment of pediatric obstructive sleep apnea (OSA). Data were compiled and analyzed using Review Manager 5.3 (Nordic Cochrane Centre).Results: After screening 135 studies, 32 were selected for review with 6 meeting inclusion criteria. In total, 668 patients aged 2 to 5 years met inclusion criteria for meta-analysis. Of these, 5 studies (166 children) that evaluated montelukast alone as treatment for pediatric OSA found a 55% improvement in the apnea-hypopnea index (AHI) (mean [SD] 6.2 [3.1] events/h pretreatment and 2.8 [2.7] events/h posttreatment; mean difference [MD] of -2.7 events/h; 95% confidence interval [CI], -5.6 to 0.3) with improvement in lowest oxygen saturation (LSAT) from 89.5 (6.9) to 92.1 (3.6) (MD, 2.2; 95% CI, 0.5-4.0). Two studies (502 children) observing the effects of montelukast with intranasal corticosteroids on pediatric OSA found a 70% improvement in AHI (4.7 [2.1] events/h pretreatment and 1.4 [1.0] events/h posttreatment; MD of -4.2 events/h; 95% CI, -6.3 to -2.0), with an improvement in LSAT from 87.8 (3.1) to 92.6 (2.2) (MD, 4.8; 95% CI, 4.5-5.1).Conclusions: Treatment with montelukast and intranasal steroids or montelukast alone is potentially beneficial for short-term management of mild pediatric OSA. [ABSTRACT FROM AUTHOR]

Purpose: To compare the short and the long term effects of momethasone and budesonid for the treatment of allergic rhinitis, on the intraocular pressure. Materials and Methods: Twenty fi ve patients were treated with momethasone furoate and 27 patients were treated with budesonid for 6 weeks. The mean follow-up time to evaluate the changes in the IOP was 50 days (38-60 days). Results: There was no difference between the groups with regard to age, gender and pretreatment IOP. Just after the treatment of allergic rhinitis and one month later, the IOPs were compared to pretreatment IOP's in both groups and no statistically significant differences were found. We also, compared the pretreatment, just after the treatment and one month later after the treatment IOP values between the groups; and no statistically significant differences were found (p<0.5). Conclusion: We concluded that the steroids used nasally as long as one month during allergic rhinitis did not cause to increase in the IOP. [ABSTRACT FROM AUTHOR]

Copyright of Medical Perspectives / Medičnì Perspektivi is the property of Dnipropetrovsk Medical Academy of Health Ministry of Ukraine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sinusitis is a common condition for which patients often consult the community pharmacist. It is, however, challenging to differentiate between common forms of sinusitis as they have nearly identical clinical representations. This review article provides an overview of sinusitis, classification, differential diagnosis between viral sinusitis, bacterial sinusitis and chronic rhinosinusitis, therapeutic management, patient education and patient referral guidelines. In addition, the recently updated guidelines on sinusitis published by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (2015), the European position paper on rhinosinusitis and nasal polyps, EPOS 2012 and the Canadian guidelines for acute bacterial rhinosinusitis (2014) will be reviewed. [ABSTRACT FROM AUTHOR]

Allergic rhinitis is one of the most common chronic diseases, affecting from 20 to 30% of adult population and 40% of children [8, 19]. In the past decades, the incidence of allergic rhinitis has been growing all over the world. 9% of the European population and 8.8 -16% of the U.S. population suffer from the pathology [1, 4]. Widespread comorbid conditions of allergic rhinitis which exacerbate the clinical pattern are asthma, sinusitis, otitis media [20, 24]. The disease is characterized by symptoms of different intensity which deteriorate the quality of life, everyday activity and productivity, even when treatment is quite effective [3, 14]. The main criteria in diagnosis of allergic rhinitis are medical history, clinical manifestations, positive skin tests and allergen-specific antibodies in blood serum.

Background: Antimicrobials treatment of Otitis media (OM) reduces some complications, but some of chronic complications, and specially otitis media with effusion (OME), seem to increase. Theoretically the usage of nasal corticosteroid sprays may prevent this problem by reducing the local inflammation around the eustachian tube. So, this study aimed to evaluate the role of nasal corticosteroid spray as an adjuvant for the treatment of OME. Methods: In a randomized, prospective clinical trial, 2 groups of 46 subjects who had OME were recruited. A questionnaire containing patients′ characters, history, complaints, otologic examinations, and the report of tympanometries was filled for all before and after treatment. We administered a period of amoxicillin and a decongestant for both group and nasal beclomethasone spray only for case group. Results: Thirty five of cases (76.1%) and 22 (47.8%) of controls had an improvement in their symptoms or the quality of hearing (p = 0.005). Partial remission was the most common finding in 52.2% of the patients in the case group but for control group there was no change (p = 0.024). The higher improvement in the tympanic retraction in the case group was significant (p < 0.05). A significant better tympanometric result has showed in the treatment of left ear in the patients of the case group (p = 0.038) but not for right ear (p = 0.136). Conclusions: We concluded that the administration of nasal beclomethasone spray as an adjuvant for the treatment of OME not only improved the results treatment but also increased the resolution of symptoms and the patients′ quality of hearing.

PurposeTo compare the profiles of the bronchodilator response (BDR) among children with asthma and/or allergic rhinitis (AR) and to determine whether BDR in these children is reduced by treatment with inhaled and/or nasal corticosteroid.MethodsSixty-eight children with asthma (mean age, 10.9 years), 45 children with comorbid asthma and AR (mean age, 10.5 years), and 44 children with AR alone (mean age, 10.2 years) were investigated. After a 2-week baseline period, all children were treated with inhaled fluticasone propionate (either 100 or 250 µg b.i.d., tailored to asthma severity) or nasal fluticasone propionate (one spray b.i.d. in each nostril) or both, according to the condition. Before and 2 weeks after starting treatment, all children were evaluated with spirometry and bronchodilator testing. BDR was calculated as a percent change from the forced expiratory volume in 1 second (FEV1) at baseline.ResultsThe mean BDR was 10.3% [95% confidence interval (CI) 8.3-12.4%] in children with asthma, 9.0% (95% CI 7.3-10.9%) in subjects with asthma and AR, and 5.0% (95% CI 4.1-5.9%) in children with AR alone (P

Objective: One of the most frequent reasons of nasal obstruction and sleep apnea in pediatrics is adenoid hypertrophy. Remaining adenoid tissue can reoccur following hypertrophied adenoid removal and a second operation may be needed. Nasal corticosteroids are utilized in order to reduce adenoid hypertrophy and eliminate adenoidectomy operation. The purpose of our study is to assess the effect of nasal corticosteroid administration after adenoidectomy on adenoid regrowth and symptom scores.Material and Method: Seventy patients who had adenoidectomy were enrolled in our study. Patients were divided into two groups. Group I (35 patients) received Mometasone furoate (40mcg/day per nostril) intranasal spray for 6 months, starting at postoperative week 3 after wound healing. As for Group II (35 patients), they received intranasal saline spray. Patients were followed up for one year. Every patient had flexible nasal endoscopy at postoperative week 3 and one year after the operation. Choana was scored according to its occlusion level by the adenoid tissue. Additionally, nasal obstruction symptoms (nasal congestion, dry mouth, snoring, nasal speaking, apnea and night coughing) were scored.Results: Remaining adenoid tissue in the nasopharynx was comparable in flexible endoscopic assessment and no significant difference was seen between postoperative week 3 nasal obstruction scores. In the flexible endoscopic assessment completed in the twelfth month of the study, significant reduction was found in Group 1 compared to Group 2 in terms of adenoid size. When patients in both groups were compared, statistically significant reduction was observed in nasal obstruction symptom scores at the twelfth month.Conclusion: This study has demonstrated that the use of steroid nasal spray following adenoidectomy significantly prevents regrowth and reduces nasal obstruction symptoms in the early period. [ABSTRACT FROM AUTHOR]

Inhaled, intranasal, and cutaneous steroids are prescribed by physicians for a plethora of disease processes including asthma and rhinitis. While the high efficacy of this class of medication is well known, the wide range of adverse effects, both local and systemic, is not well elucidated. It is imperative to monitor total steroid burden in its varied forms as well as tracking for possible side effects that may be caused by a high cumulative dose of steroids. This review article highlights the adverse effects of different steroid modalities as well as suggests a monitoring tool to determine steroid totality and side effects. [ABSTRACT FROM AUTHOR]

Background: Epidemiologic studies have shown conflicting results regarding the role of traffic pollution in the development of allergic disease. This study investigated the relationship between living close to traffic and ever dispense of prescribed oral antihistamines or nasal anti-allergic medication, among young children. The underlying aim was to investigate if children growing up close to traffic pollution are at higher risk of developing allergy in early childhood.Methods: We investigated a birth cohort in southern Sweden, consisting of N = 26 128 children (0-6 years) with health outcome and exposure data. Of these children, N = 7898, had additional covariate information. Traffic intensity and yearly averages of dispersion-modeled concentrations of NOX (100 × 100 m grid) at residential addresses, were linked with registry data on dispensed allergy medication (the Swedish Prescribed Drug Register). Individual level covariate information was obtained from questionnaires distributed to parents at Child Health Care-center visits, eight months after birth. Cox proportional hazards regression was used for the statistical analyses.Results: Living in close proximity to a road with equal to or greater than 8640 cars/day (compared to 0-8639 cars/day), was not associated with higher incidence of ever dispensed oral antihistamine or nasal anti-allergic medication, with or without adjustment for confounders (sex, breastfeeding, parental allergy, parental origin, season, and year of birth). Similar results were found in relation to NOX.Conclusions: Traffic-related exposure was not associated with higher incidence of ever dispensed medication against allergy, in children 0-6 years in southern Sweden. These results indicates that traffic-related exposure may not be a risk factor for early onset allergy in children in southern Sweden. However, children with dispense of prescribed allergy medication may be a selected subgroup, and the results for this group may not be generalizable to all children with allergy. [ABSTRACT FROM AUTHOR]

Keywords: allergy diagnosis; allergy treatment; common cold; ENT (rhinitis; sinusitis; nasal polyps...); nasal corticosteroids EN allergy diagnosis allergy treatment common cold ENT (rhinitis sinusitis nasal polyps...) nasal corticosteroids 3839 3840 2 12/01/21 20211201 NES 211201 Niels Mygind (1942-2015) has been a real legend in allergy since the 1970s and in common with legends, much about him remains a mystery. In 2014, he published his last book on the common cold aimed at the general public (Figure 2),6 and sadly on 6 January 2015, Niels passed away. Allergy diagnosis, allergy treatment, common cold, ENT (rhinitis, nasal polyps...), sinusitis, nasal corticosteroids. [Extracted from the article]

Purpose: To assess the efficacy of nasal expiratory sound analysis in determining the degree of nasal obstruction. Materials and Methods: We have analyzed and recorded the expiratory nasal sounds in 18 healthy controls and in 30 patients with inferior turbinate hypertrophy before and after the administration of nasal corticosteroid treatment. Analysis consisted of the time-expanded waveform, spectral analysis with time-averaged fast Fourier transform and waveform analysis of nasal sound. Results: Before treatment, an increase in sound intensity at high frequency was observed in the sound analyses of the patients, whereas after treatment, a decrease in sound intensity at high frequency was noted in the sound analyses of the patients. The differences between the patients and the control group were statistically significant. Data obtained with the Odiosoft-Rhino method were correlated with symptom scores and endoscopic examination. Conclusion: Expiratory nasal sound is a practical and objective tool, which can be reliably used not only for the assessment of the degree of nasal blockage but also for the comparison of different treatment alternatives. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: To test the antibacterial properties of three commercially available nasal corticosteroid preparations containing Mometasone Furoate (MF), Fluticasone Propionate (FP) and Fluticasone Furoate (FF) against S. pneumoniae, S. viridans, S. aureus, H. influenza, P. aeruginosa and E. coli. Methods: Study Design: Experimental in vitro study using the disc diffusion method. Clinical isolates of Streptococcus pneumoniae, Hemophilus influenzae, Streptococcus viridans, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli were inoculated on separate plates. 0.15 ml of nasal corticosteroid preparations containing MF, FP and FF were applied to blank paper discs, then placed on the plates, including an empty disc. Following 24 and 48 hours of incubation, the inhibition zones were measured to the nearest mm from the point of abrupt inhibition of growth. Results: After 24 and 48 hours of incubation, S. pneumoniae, S. viridans, and S. aureus showed inhibition zones to all three preparations. S. aureus and S. viridans show the largest zones of inhibition at 24 and 48 hours respectively. H. influenza, P. aeruginosa and E. coli were negative. The inhibition zones of each bacteria were shown to be statistically different. The preparation containing FP had the largest zone of inhibition at 24 and 48 hours, although post hoc tests showed their difference was not significant. Conclusion: The present study demonstrates possible antimicrobial properties of commercially-available nasal corticosteroid preparations. However, it is unclear whether these can be attributed to the steroids, their excipients, or both. Further studies testing each component may offer better insights into their therapeutic use. Keywords: Mometasone Furoate, Fluticasone Propionate, Fluticasone Furoate, Antibacterial, Nasal Corticosteroids, Allergic Rhinitis, Acute Bacterial Rhinosinusitis

Summary: The obstructive sleep apnea syndrome is common and its prevalence is expected to increase with the current obesity epidemic. If left untreated, it is associated with important morbidity such as growth failure, neurocognitive impairment, systemic and pulmonary hypertension, and endothelial dysfunction. Recent research has shown that many children, especially the obese or those with other underlying medical conditions, have residual obstructive sleep apnea after adenotonsillectomy (the primary treatment for childhood obstructive sleep apnea). These children could be effectively treated with continuous positive airway pressure but poor adherence is a significant limitation of this therapy. Therefore, new treatment modalities for the pediatric obstructive sleep apnea syndrome are needed. Current research has focused on newer therapies for pediatric obstructive sleep apnea, such as anti-inflammatories, dental treatments, high-flow nasal cannula, and weight loss. However, there are few randomized controlled trials assessing the effectiveness of these therapies. Further research is warranted. [Copyright &y& Elsevier]

A retrospective study has explored the progress of incidence of orbital cellulitis in childhood and its therapy. Children treated between 2007 and 2011 at KDORL. The diagnosis of acute sinusitis with predominance of maxillary sinusitis was confirmed in the whole group. 65 of 107 patients were admitted into the hospital and 9 underwent an operation using the FESS technique. The results show the necessity of early therapy - therapy with antibiotics and additional therapy, especially using nasal corticosteroids whose importance has increased in recent years. [ABSTRACT FROM AUTHOR]

Background: The united allergic airway is a theory that connects allergic rhinitis (AR), chronic rhinosinusitis, and asthma, in which seemingly disparate diseases, instead of being thought of separately, are instead viewed as arising from a common atopic entity. Objective: This article describes patients with such diseases; explores ideas suggesting a unified pathogenesis; elucidates the various treatment modalities available, emphasizing nasal corticosteroids and antihistamines; and provides an update of the literature. Methods: A literature review was conducted. Conclusion: The aggregation of research suggests that AR, asthma, and chronic rhinosinusitis are linked by the united allergic airway, a notion that encompasses commonalities in pathophysiology, epidemiology, and treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Antimicrobials treatment of Otitis media (OM) reduces some complications, but some of chronic complications, and specially otitis media with effusion (OME), seem to increase. Theoretically the usage of nasal corticosteroid sprays may prevent this problem by reducing the local inflammation around the eustachian tube. So, this study aimed to evaluate the role of nasal corticosteroid spray as an adjuvant for the treatment of OME.METHODS: In a randomized, prospective clinical trial, 2 groups of 46 subjects who had OME were recruited. A questionnaire containing patients' characters, history, complaints, otologic examinations, and the report of tympanometries was filled for all before and after treatment. We administered a period of amoxicillin and a decongestant for both group and nasal beclomethasone spray only for case group. RESULTS: Thirty five of cases (76.1%) and 22 (47.8%) of controls had an improvement in their symptoms or the quality of hearing (p = 0.005). Partial remission was the most common finding in 52.2% of the patients in the case group but for control group there was no change (p = 0.024). The higher improvement in the tympanic retraction in the case group was significant (p < 0.05). A significant better tympanometric result has showed in the treatment of left ear in the patients of the case group (p = 0.038) but not for right ear (p = 0.136). CONCLUSIONS: We concluded that the administration of nasal beclomethasone spray as an adjuvant for the treatment of OME not only improved the results treatment but also increased the resolution of symptoms and the patients' quality of hearing. [ABSTRACT FROM AUTHOR]

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Abstract: To assess the influence of international guidelines on the management of intermittent allergic rhinitis in France, a sample of 226 randomly chosen general practitioners were surveyed by questionnaire. The objectives were to evaluate their approach to nasal steroid prescription and their assessment of this treatment. Only 28% of these doctors claimed to systematically attempt to diagnose allergy, and only 17% systematically performed an endonasal examination. The survey also showed that 97% relied on evaluation of seasonal symptoms to define the intermittent aspect of their patients’ allergic rhinitis. They used the degree of nasal obstruction to define the severity of the rhinitis. Nasal steroids (59%) and H1 antihistamines (45%) were the principal drugs prescribed. They determined the duration of nasal steroid treatment according to the severity of the symptoms. These physicians had a very positive opinion on the usefulness of nasal steroid therapy. This type of survey is useful in assessing the impact of guidelines on the management of allergic rhinitis in general practice in France. [Copyright &y& Elsevier]

Background: A recent observational study suggests that intranasal corticosteroids used to treat allergic rhinitis are effective at preventing asthma outcomes, such as emergency visits. The approach to data analysis may have led to biased results because of misclassification of immortal time. Objective: To illustrate the bias in the cohort approach and to present the proper time-dependent analysis by replicating the recent study using data from another source. Methods: From an existing cohort of 30,569 patients with asthma age 5 to 44 years and identified from the Saskatchewan Health databases (1975-1997), we formed the cohort of all subjects who were in the source population between January 1, 1989, and December 31, 1991. Subjects were followed to the first asthma hospitalization. All prescriptions dispensed during follow-up were identified. We replicated the time-fixed approach to data analysis used in the recent study and compared it with time-dependent approaches. Results: The cohort included 20,173 subjects, of whom 1849 were hospitalized for asthma between January 1, 1989, and December 31, 1991. The time-fixed approach misclassified more than 5000 person-years of follow-up, corresponding to 44% of the exposed person-time. As a result, the rate ratio of asthma hospitalization after any use of nasal corticosteroids (NCSs) was 0.57 by the biased time-fixed approach compared with 1.13 by the proper time-dependent approach. The time-fixed approach produced a paradoxical protective effect of NCS with 1 or less canisters dispensed per year (odds ratio, 0.47), which was further exaggerated when the cohort was extended to 5 years (odds ratio, 0.33). Adjusted time-dependent analyses found no protective effect, even when NCSs were dispensed regularly (rate ratio, 1.10; 95% CI, 0.54-2.21). Conclusion: The time-fixed approach to the analysis of the effectiveness of NCSs on asthma outcomes leads, by its inherent misclassification of immortal time, to a considerable exaggeration of the protective effect of these medications in preventing severe asthma exacerbations. [Copyright &y& Elsevier]

Loteprednol etabonate (LE) is a novel soft steroid that was designed to improve the benefit/risk ratio of topical corticosteroid therapy. This study assesses the clinical efficacy and safety of three different doses of LE nasal spray in seasonal allergic rhinitis (SAR).In this single-center, double-blind, placebo-controlled, parallel-group trial 165 subjects with SAR to grass pollen received daily single doses of either 100, 200, 400 μg LE nasal spray, or placebo for 14 days. The patients underwent three 4-h allergen challenges with grass pollen in an environmental exposure unit at a screening visit (baseline) and on days 7 and 14 of treatment. Standardized nasal symptom scores were obtained every 20 min. Nasal flow, nasal secretions, and FEV1 were measured every hour during allergen challenges.After 14 days of treatment, patients who received 400 μg LE had significantly lower total nasal symptom scores compared with those receiving placebo (P = 0.007). LE400 reduced rhinorrhea, nasal congestion, nasal itching, the amount of nasal secretions, and improved nasal flow as compared with placebo (P < 0.05). LE100 and LE200 were not significantly different from placebo. All treatments were well tolerated.Loteprednol 400 μg once daily is superior to placebo and the only effective dose tested in improving nasal symptoms and objective parameters in patients with SAR. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis with nasal polyps (CRSwNP) frequently remains uncontrolled despite maximal medical therapy and sinonasal surgery, presenting several unmet needs and challenges. Omalizumab previously demonstrated efficacy in CRSwNP in duplicate phase 3, randomized, placebo-controlled trials (POLYP 1, POLYP 2). This open-label extension evaluated the continued efficacy, safety, and durability of response of omalizumab in adults with CRSwNP who completed POLYP 1 or 2. After 24 weeks of omalizumab or placebo in POLYP 1 and 2, patients (n = 249) received open-label omalizumab plus background nasal mometasone therapy for 28 weeks and were subsequently followed for 24 weeks after omalizumab discontinuation. Efficacy end points assessed change from baseline for the coprimary end points, Nasal Polyp Score and Nasal Congestion Score, and the secondary end points of Sino-Nasal Outcome Test 22, Total Nasal Symptom Score and its components, and University of Pennsylvania Smell Identification Test scores. Safety objectives included incidence of adverse events and adverse events leading to omalizumab discontinuation. Patients who continued omalizumab experienced further improvements across coprimary end points and secondary end points through 52 weeks. Patients who switched from placebo to omalizumab experienced favorable responses across end points through week 52 that were similar to POLYP 1 and 2 at week 24. After omalizumab discontinuation, scores gradually worsened over the 24-week follow-up, but remained improved from pretreatment levels for both groups. The safety profile was similar to previous reports. The efficacy and safety profile from this study supports extended omalizumab treatment up to 1 year for CRSwNP with inadequate response to nasal corticosteroids. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Cedar pollinosis (CP), a common form of seasonal allergic rhinitis (AR), is a substantial medical problem in Japan due to its high prevalence and severe symptoms. Omalizumab (anti-IgE therapy) has previously proven to be effective in CP/AR, but no studies for inadequately controlled severe CP/AR despite standard-of-care (SoC) have been conducted., Objective: To determine the efficacy of omalizumab added to SoC in patients with inadequately controlled severe CP in a randomized, double-blinded, placebo-controlled, phase III study., Methods: Adult/adolescent patients with severe CP whose symptoms were inadequately controlled despite nasal corticosteroids plus 1 or more oral medications in the previous 2 seasons were randomized to receive omalizumab (n = 162) or placebo (n = 175). All patients received concomitant antihistamines and nasal corticosteroids as SoC. The primary endpoint was the mean nasal symptom score during the severe symptom period. Secondary endpoints included mean ocular symptom score, quality of life (QoL), and safety., Results: The SoC + omalizumab treatment had statistically significantly and clinically important lower nasal (least squares mean difference, -1.03, P < .001) and ocular (-0.87, P < .001) symptom scores compared with SoC + placebo, respectively. Differences in scores for individual components of nasal and ocular symptoms were also statistically and clinically significant. SoC + omalizumab also improved QoL scores as overall and in all domains. No unexpected safety signals were observed., Conclusions: In patients with severe CP, omalizumab added to SoC demonstrated consistent efficacy in improving symptoms and QoL, and was well tolerated. These results indicate that omalizumab could be a promising therapeutic option for severe CP/AR., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

This article evaluates the role of allergen immunotherapy (AIT) in the treatment of allergic rhinitis (AR). AIT has been shown to be effective in treating AR symptoms with resultant improvements in overall quality of life, comorbid illnesses, and medication requirements. Persistent clinical benefits have been shown years after AIT treatment discontinuation. AIT may prevent the progression of AR to asthma. AIT may more cost-effective than pharmacotherapy. Multiple individual studies and systematic reviews provide strong evidence for the clinical effectiveness of AIT in the treatment of AR. Cost-effectiveness and disease modification of AIT compared with standard drug treatment are additional advantages., (Copyright © 2019 Elsevier Inc. All rights reserved.)