Search

Background and Objective: We reported neutrophil-associated tissue damage in cedar pollinosis subjects with refractory nasal symptoms prior to pollinosis season. Because the leukotriene receptor antagonist, montelukast, can inhibit neutrophil recruitment and activation, we investigated its effects on symptom relief and nasal neutrophilia in pollinosis subjects in the preseason. Methods: In the pollinosis preseason, symptomatic (PreSyP, n = 149) and asymptomatic subjects (PreAsP, n = 145) were prophylactically treated, and in season symptomatic subjects (InSyP, n = 134) were treated. Individuals were assigned to 1 of 2 treatment protocols: administration of cetirizine and fluticasone nasal spray (Cet-Flu) or montelukast, fexofenadine, and fluticasone nasal spray (Mo-Fex-Flu). Differences in symptom relief and inflammatory cell infiltration in nasal swabs were investigated. Results: In pollen season, 59% of PreSyP subjects given Cet-Flu and 88% of those treated with Mo-Fex-Flu had none or mild symptoms (P <.00001). In PreAsP subjects in season, 71% of Cet-Flu and 98% of Mo-Fex-Flu recipients had none to mild symptoms (P <.0000001). The proportions of subjects in the PreSyP group with nasal swabs with neutrophils 1+ to 3+ before and after treatment by Mo-Fex-Flu were 59% and 18%, respectively (P <.0001), and in PreAsyP, subjects with neutrophils 2+ to 3+ were 17% and 5%, respectively (P =.034). In PreSyP, a significant reduction in the percentage of subjects with mast cells >1+ was seen following both Cet-Flu (P =.027) and Mo-Fex-Flu (P =.0014) treatments. Conclusion: In PreSyP and PreAsP subjects, treatments with Mo-Fex-Flu were more effective than Cet-Flu to reduce nasal symptom scores. These effects were associated with reduction in the number of neutrophils and mast cells in nasal swabs. [ABSTRACT FROM AUTHOR]

Background: It is difficult to identify the onset of allergic rhinitis in infants because making a conclusive diagnosis can be challenging. Objective: We used a combination of cell differentials in nasal swabs and immunoglobulin E (sIgE) antibody values to food and inhalant allergens to make the diagnosis and identify relevant allergens for investigation of the onset of allergic rhinitis. Methods: We studied 302 children, 2 to 120 months old, who visited our clinic for rhinorrhea. Nasal swabs were taken from all children, and neutrophils (N), eosinophils (Eo), and mast cells (Mc) were identified by nasal cytology and their numbers were estimated. Levels of sIgE antibodies to various food and inhalant allergens were determined in patients with nasal Eo and Mc. Results: Percentages of participants with Eo-Mc and Eo-Mc-N at 2–14 (n 84), 15–24 (n 57), 25–60 (n 73), and 61–120 months of age (n 88) were 20, 23, 58, and 65%, respectively. There were no significant differences between the 2–14 and 15–24, and 25–60 and 61–120 months age groups, but there was a significant difference between the 15–24 and 25–60 months age groups (p 0.00013). The percentages of participants with sIgE antibodies to food and inhalant allergens as solitary or main allergen were 12%/0% at 2–14 months old, 10.5%/7% at 15–24 months old, 1.3%/42.4% at 25–60 months old, and 0%/56.8% at 61–120 months old, respectively with a significant difference between 15–24 and 25–60 months old groups (p 0.00025) for inhalant allergens. Conclusion: Allergic rhinitis associated with inhalant allergens in infants 15 months of age is rare, but it is tempting to postulate that symptoms of rhinitis in these infants may be associated with sIgE antibodies to food allergens. Transition of sIgE responses from food to inhalant allergens occurred after 15 months of age, and sIgE antibodies to inhalant allergens were predominant after 25 months. [ABSTRACT FROM AUTHOR]