Impact of temperature exposure on nasal symptoms in temperature-sensitive chronic rhinitis patients

Validation of the Visual Analog Scale in Perennial Allergic and Non-Allergic Rhinitis: Association With Symptom Severity and Quality of Life.

An increased production of several chemoattractants, responsible for guiding the eosinophilic inflammatory process, has been reported in chronic rhinitis. The aim of this study was to evaluate nasal secretion levels of monocyte chemoattractant protein-1 (MCP-1), MCP-3, and regulated on activation normal T cell expressed and secreted (RANTES) and to correlate those levels with nasal symptoms and degree of eosinophilia in patients with nonallergic rhinitis with eosinophilia syndrome (NARES) and perennial allergic rhinitis (PAR). Fourteen patients with PAR and 14 NARES patients were recruited for this cross-sectional study. Fourteen healthy subjects were included as controls. The concentrations of MCP-1, MCP-3, and RANTES in nasal secretions were measured using enzyme-linked immunosorbent assay (ELISA). Eosinophil counts were performed by percentage of differential granulocyte counts during cytological examination of scraped nasal mucosa obtained from the inferior turbinate. Therefore, we scored rhinitis patients according to nasal symptom score. We found significantly higher concentrations of MCP-1 (p < 0.0001), MCP-3 (p = 0.018), and RANTES (p < 0.0001) in nasal fluid of NARES patients compared to patients with PAR. In PAR patients, we found positive correlation between RANTES levels and nasal symptom score and eosinophil counts. In patients with NARES, the concentrations of MCP-1 and RANTES were associated with nasal symptom score and percentage of eosinophils. NARES is characterized by higher degree of eosinophilic inflammation than PAR. RANTES correlates well with the level of eosinophilic inflammation in both diseases. The measurement of chemokine levels in nasal secretions could be useful in evaluating the degree of chronic nasal inflammation.

Multiple minimally invasive techniques for chronic rhinitis treatment focus on posterior nasal nerve ablation. We conducted a systematic review and meta-analysis to evaluate the efficacy of cryotherapy and radiofrequency ablation for alleviating symptoms in patients with allergic and nonallergic rhinitis. We retrieved studies from PubMed, Scopus, Embase, Web of Science, and Cochrane Database up to July 2023. Data on the impact of cryotherapy and radiofrequency ablation on quality of life and symptom ratings of rhinitis were extracted and evaluated. An analysis of 12 studies involving 788 patients demonstrated significant improvements in quality of life and rhinitis-related symptoms (nasal obstruction, itching, rhinorrhea, and sneezing) in patients treated with cryotherapy or radiofrequency ablation (symptom score at 24 months and quality of life score at 3 months). However, radiofrequency ablation had a more positive effect on nasal symptoms after 3 months than cryotherapy. Nonallergic rhinitis patients responded more favorably to posterior nerve ablation than patients with allergic rhinitis. Both techniques enhanced disease-specific quality of life during the initial 3 months of treatment (cryotherapy, 84.6%; radiofrequency, 81.6%; P=0.564). After 3 months of treatment, a clinical improvement in all nasal symptoms (minimal clinically important difference in the total nasal symptom score: >1.0 points) was seen in 81.8% and 91.9% of patients who underwent cryotherapy and radiofrequency ablation, respectively (P=0.005), suggesting that radiofrequency is more likely to lead to clinical improvement. Rhinitis-associated subjective symptom scores and quality of life may be improved by both cryotherapy and radiofrequency ablation. Ablation was more efficacious than cryotherapy for nasal symptoms in patients with nonallergic rhinitis. To corroborate these findings, further randomized controlled studies directly comparing these two techniques are warranted.

Hyeonggaeyeongyo-tang (HYT) is an ancient formula of oriental medicine traditionally used to treat rhinitis; however, clinical evidence has not yet been established. The aim of this study was to investigate the short-term and long-term efficacy and safety of HYT for chronic rhinitis. Adult subjects with chronic rhinitis symptoms were recruited. The subjects received HYT for 4 weeks and had follow-up period of 8 weeks. Any medicines used to treat nasal symptoms were not permitted during the study. The skin prick test was performed to distinguish the subjects with allergic rhinitis from those with nonallergic rhinitis. After treatment, the total nasal symptoms score and the Rhinoconjunctivitis Quality of Life Questionnaire score significantly improved in the whole subject group, in the allergic rhinitis group, and in the nonallergic rhinitis group, with no adverse events. This improvement lasted during a follow-up period of 8 weeks. Total IgE and eosinophil levels showed no significant difference after treatment in the allergic rhinitis group. HYT improved nasal symptoms and quality of life in patients with allergic rhinitis and nonallergic rhinitis. This is the first clinical study to evaluate the use of HYT to treat patients with rhinitis. This trial has been registered with the ClinicalTrials.gov Identifier NCT02477293.

Intranasal corticosteroid therapy has exhibited effectiveness for improving nasal symptoms and quality of life (QOL) scores associated with seasonal allergic rhinitis. We prospectively investigated the efficacy of mometasone furoate nasal spray (MFNS) for improving the total nasal symptom score, QOL score, and sleep quality in subjects with perennial allergic rhinitis (PAR). Nasal airway conditions were also objectively assessed by measuring nasal nitric oxide (NO). Fifty-seven patients with PAR were randomized to MFNS or placebo for a 14-day, double-blind, crossover study. The subjects recorded their symptoms on nasal symptom forms and a visual analog scale. QOL and sleep quality were surveyed in accordance with the Japanese version of the Rhinoconjunctivitis Quality of Life Questionnaire (JRQLQ) and the Japanese version of the Epworth Sleepiness Scale. Nasal NO was measured during a single exhalation using a chemiluminescence analyzer. MFNS treatment achieved significant reductions versus placebo for total nasal symptoms (p < 0.001). There were significant decreases of the usual daily activity domain (p < 0.005), outdoor activities (p < 0.01), social function (p < 0.05), and the overall QOL score (p < 0.05) of JRQLQ with MFNS therapy versus placebo. A significant reduction of the sleepiness scale was also observed in the MFNS group with high sleep disturbance (p < 0.01). A significant decrease of nasal NO was found in the MFNS group (p < 0.01), especially among patients with severe nasal symptoms (p < 0.005). This prospective study indicated that MFNS therapy significantly improves nasal symptoms, QOL, sleep quality, and upper airway condition in Japanese subjects with PAR.

Although symptoms and signs of allergic rhinitis (AR) and nonallergic rhinitis (NAR) are similar, treatment and follow-up are different. We aimed to find predictive factors that can be used in primary health care to differentiate AR from NAR. We made a retrospective analysis of cases aged 6-18 years old who were diagnosed as having chronic rhinitis within a 1-year period. Skin-prick tests were done and severity of rhinitis symptoms was recorded on a visual analog scale in all patients. There were 472 cases whose medical records were complete and included in the analysis. The median age was 11 (interquartile range [IQR], 5) years. AR was diagnosed in 363 patients (76.9%) and was different from NAR with respect to: median age (p = 0.042), seasonality of the symptoms (p = 0.002), persistent symptoms (p = 0.003), moderate/severe according to visual analogue scale (VAS) score (p = 0.017), conjunctivitis (p < 0.001), parental history of AR (p = 0.026), rhinorrhea (p < 0.001), sneezing (p = 0.005), mucosal pallor (p = 0.004), and response to antihistamines (p = 0.035). All parameters with a significance of p < 0.1 between AR and NAR were included in logistic regression analysis. Seasonality, sneezing, moderate/severe rhinitis, and response to antihistamines were identified as significant independent parameters to differentiate AR from NAR. Features of rhinitis patients with seasonality, sneezing, moderate/severe rhinitis, and response to antihistamines may help in differentiation of AR from NAR at the primary care level.

Chronic rhinitis (CR) is divided into two main categories: allergic rhinitis (AR) and nonallergic rhinitis (NAR). These conditions are more recognizable to an experienced clinician, as they can be more clearly demarcated diagnostically. However, an additional 30% to 50% of patients with CR might have an overlap of NAR and AR, referred to as mixed rhinitis (MR). Progress in elucidating the pathophysiologic mechanisms behind MR and NAR has been made in the past several years, and there are now several guidelines published to assist the clinician in accurately diagnosing AR, NAR, and MR. Clinical history and subjective symptoms can provide clues for differentiating AR from MR and NAR, but allergy testing is recommended to confirm these conditions. Progress in accurately diagnosing patients with CR will be made as studies incorporate subjective (i.e., validated questionnaires such as the irritant index questionnaire (IIQ), medication responsiveness, and quality-of-life tools) and objective (i.e., nasal cytologic testing, nasal provocation, and biomarkers) methods characterizing rhinitis subtypes.

Background Over 90% of allergic rhinitis (AR) patients have ocular symptoms during the pollen season, but these are routinely neglected and under-treated. New treatment options should provide relief not only from all nasal symptoms, but all ocular symptoms too, since patients frequently present with symptoms from both nasal and ocular origin. The reflective total of 7 symptom scores (rT7SS) is an endpoint measuring the entire AR symptom complex. It comprises both the reflective total nasal symptom score (rTNSS) and the reflective total ocular symptom score in one global score (max score=42). Objective To assess the efficacy of MP29-02* (a novel intranasal formulation of azelastine hydrochloride [AZE] and fluticasone propionate [FP]) in providing relief from the entire AR symptom complex compared to commercially available intranasal AZE or FP nasal sprays and placebo, in patients with seasonal AR (SAR). Methods 610 patients (>=12 years old) with moderate-to-severe SAR were randomized into this double-blind, placebocontrolled, 14-day, parallel-group trial to MP29-02*, commercially-available AZE or FP nasal sprays, and placebo (all given as 1 spray/nostril bid [total daily doses: AZE = 548 µg; FP=200 µg]. The primary efficacy variable was change from baseline in rTNSS (AM +PM), over 14-days. Change from baseline in rT7SS was assessed post-hoc via an analysis of covariance. Results MP29-02* most effectively treated the entire rhinitis symptom complex, reducing the rT7SS from baseline by -8.74 compared to -6.05 for FP (Diff: -2.69; 95% CI: -4.33, -1.06; p=0.0013), -5.83 for AZE (Diff -2.91; 95% CI: -4.52, -1.31; p=0.0004) and -3.55 for placebo (Diff -5.19; 95% CI: -6.71, -3.68; p<0.0001). The relative difference was 52% to FP and 56% to AZE, making MP2902* twice as effective as either firstline therapy. This benefit was observed during the first day of treatment and was sustained over the entire course of treatment. Conclusion Compared to currently available first-line therapy for AR, MP29-02* most effectively treats the entire rhinitis symptom complex, comprising the most commonly reported nasal and ocular symptoms. Such a universal treatment option should preclude the need for concomitant eye drops, and may be considered the drug of choice for AR management. *Dymista

Azelastine is a potent H1-antihistamine, which is available as a topical nasal spray and indicated for both seasonal allergic and non-allergic vasomotor rhinitis. In addition to its antihistaminic effects, it has also been shown to have a number of other potentially important attributes, including effects on cytokines, adhesion molecules and inflammatory cells. Azelastine nasal spray has been shown to benefit patients who have not responded adequately to loratadine and fexofenadine, and is significantly more efficacious than cetirizine and levocabastine in patients with seasonal allergic rhinitis. Given its unique pharmacologic properties and clinical profile, azelastine maintains an important role in the treatment of chronic rhinitis.

Allergic rhinitis (AR) has been shown to be a significant global health burden. Despite the existence of pharmacological treatments, mainly antihistamines, nasal corticosteroids, and decongestants, many individuals with seasonal allergies turn to alternative herbal medicines and nutritional supplements for the management of symptoms. The primary objective of the current study is to evaluate the efficacy and safety of a 500mg daily dose of a yeast β-glucan preparation (M-Gard®) on reducing the severity of nasal and ocular symptoms in a population with seasonal AR. This randomised placebo-controlled crossover trial will evaluate the effect of 500mg of a 14-day M-Gard® or placebo (microcrystalline cellulose) supplementation period on the relief of grass pollen-induced AR symptoms in 20 generally healthy adults (18-65years) with a history of recurrent seasonal AR. Participants will consume M-Gard® or placebo during 14days, starting 12days before the antigen challenge and ending 2days after. Each supplementation period will be separated by a 2-week washout period. Allergy symptoms will be assessed at baseline (day 0) and on days 12-14 using a visual analogue scale (VAS) rating AR symptom severity as primary outcome (nasal congestion, sneezing, itchy nose, runny nose and watery eyes) and validated questionnaires as secondary outcomes (Reflective Total Nasal Symptom Scores (rTNSS), Reflective Total Ocular Symptom Scores (rTOSS), Rhinitis Control Scoring System (RCSS), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ)). In addition, onset of relief, use of rescue medication, and adverse events will be monitored for up to 2days after the grass allergen challenge. Peak nasal inspiratory flow (PNIF) and pathology markers (cytokines, histamine, tryptase, and allergen-specific IgE) will also be measured. All outcomes will be analysed as the change from baseline and between-group comparisons will be assessed using appropriate models. The study hypothesis is that M-Gard® supplementation will be more effective than placebo in reducing AR symptoms. This research will strengthen the evidence base supporting the use of M-Gard® as a supplement for the management of AR. ClinicalTrials.gov NCT06907680.Registered on March 27, 2025.

Demonstration of nasal hyperreactivity (NHR) in allergic and nonallergic rhinitis remains a diagnostic challenge because of the lack of a clinically attractive protocol with high sensitivity and specificity. Our aim was to evaluate the feasibility of a shortened cold dry air (CDA) provocation protocol for the diagnosis of NHR in patients with allergic rhinitis (AR) and idiopathic rhinitis (IR). Twelve AR patients, 12 IR patients, and 12 controls were exposed to air at -10°C and <10% humidity for 15 minutes. Nasal symptoms were subjectively evaluated by visual analogue scale (VAS), and nasal obstruction was objectively measured by peak nasal inspiratory flow (PNIF) before and after CDA exposure. NHR was defined as a drop in PNIF larger than 20% from baseline upon CDA challenge. Nasal CDA exposure induced nasal obstruction in AR and IR patients but not in controls. The VAS for nasal obstruction increased significantly in IR patients (post-CDA: 9.1 cm [6.9, 9.7] vs. pre-CDA: 5.5 cm [5.0, 8.9], P = .004) as well as in AR patients (post-CDA: 5.0 cm [1.3, 6.6] vs. pre-CDA: 0.8 cm [0.0, 1.7], P = .001). PNIF values showed a significant decrease in the AR (post-CDA: 50.0 L/min [37.5, 97.5] vs. pre-CDA: 95.0 L/min [52.5, 127.5], P = .002) and IR (post-CDA: 75.0 L/min [47.5, 102.5] vs. pre-CDA: 100.0 L/min [67.5, 130.0], P = .002) group after CDA provocation, which was not observed in the controls (P = 1.000). The sensitivity and specificity of CDA provocation for diagnosis of NHR were 66.7% and 100%, respectively, for both IR and AR. In contrast to nasal obstruction, rhinorrhea and sneezing were not induced by CDA exposure. This study demonstrates that a short nasal CDA exposure is a reliable method for the diagnosis of NHR in rhinitis patients, with a high sensitivity and specificity.

Allergic rhinitis (AR) is a prevalent chronic inflammatory airway disease with a range of symptoms that can significantly impact quality of life. This study aimed to explore the relationship between the severity of nasal symptoms and sexual function in AR patients. A case-control study involving 1034 AR patients and 422healthy controls was conducted. Nasal symptoms were assessed using Visual Analog Scale (VAS) scores, while sexual function was evaluated using the International Index of Erectile Function (IIEF) for males and the Female Sexual Function Index (FSFI) for females. In female AR patients, total FSFI scores, as well as scores for subjective arousal, orgasmic function, and intercourse satisfaction, were significantly decreased compared to controls. Nasal obstruction scores were significantly correlated with sexual desire, subjective arousal, orgasmic function, intercourse satisfaction, and total FSFI scores (r=-0.3176, r=-0.2106, r=-0.6129, r=-0.3430, r=-0.5233). Dysosmia scores also correlated with subjective arousal, orgasmic function, intercourse satisfaction, and total FSFI scores (r=-0.4331, r=-0.3123, r=-0.5259, r=-0.5436). Overall disease severity correlated significantly with subjective arousal, orgasmic function, intercourse satisfaction and total scores (r=-0.2908, r=-0.3703, r=-0.3739, r=-0.4225). Among male AR patients, lower total IIEF scores were observed, with reductions in erectile function, sexual desire, and overall satisfaction. Nasal obstruction scores were negatively correlated with erectile function, orgasmic function, sexual desire, and total IIEF scores (r=-0.8544, r=-0.3869, r=-0.2772, r=-0.6855). Furthermore, rhinorrhea scores showed significant correlations with overall satisfaction and total IIEF scores (r=-0.3711, r=-0.2680), and dysosmia scores were significantly associated with erectile function, orgasmic function, sexual desire, and total IIEF scores (r=-0.5048, r= -0.2904, r=-0.5607, r=-0.4733). Overall disease severity correlated significantly with erectile function, orgasmic function, sexual desire and total scores (r=-0.5385, r=-0.2034, r=-0.3257, r=-0.4833). This study underscores the negative correlations between nasal symptoms and sexual function in AR patients, suggesting that AR may contribute to sexual dysfunction.

Allergic rhinitis (AR) is a chronic systemic allergic disease with an association reported between allergy and anxiety. The objective of the current study was therefore to investigate and retrospectively evaluate the factors that may possibly induce state and trait anxiety among patients with AR and vasomotor rhinitis (VMR). A total of 253 outpatients suffering from AR and 108 suffering from VMR were assessed for nasal symptoms experienced during the 14 days prior to assessment. All patients scored the severity of their symptoms on a visual analogue scale (VAS) and answered the State-Trait Anxiety Inventory (STAI) questionnaire to evaluate their state (STAI-S) and trait (STAI-T) anxiety scores. Pearson's correlation and multiple regression tests were employed to assess correlations between symptom scores and anxiety status scores. The STAI-S/T scores were not significantly different between AR and VMR patients; however, for AR patients, STAI-S and STAI-T were significantly associated with nasal obstruction and the total nasal symptom scores. Multiple regression analysis further demonstrated that only nasal obstruction significantly influenced both STAI-S and STAI-T scores. In contrast, nasal itching and total nasal symptom scores were significantly correlated with the STAI-S and STAI-T scores in VMR patients, whereas continuous sneezing VAS scores were significantly associated with only the STAI-S score. However, multiple regression analysis showed that the associations between any of the 4 nasal symptom scores and STAI-S and STAI-T scores were not significant. Nasal obstruction may play a prominent role in mediation of anxiety in patients suffering from AR, but not in patients suffering from VMR.

BACKGROUND. Vasomotor rhinitis represents a significant global health burden, with prevalence rates ranging from 5 to 25 %. It is a subtype of non-allergic rhinitis, a heterogeneous group of disorders characterized by rhinitis symptoms not caused by atopy or infection, which are sometimes grouped with other phenotypes such as gustatory, hormonal, or drug-induced rhinitis. In contrast to allergic rhinitis, which involves IgE-mediated immune responses, vasomotor rhinitis is driven by neurogenic and autonomic dysfunction. Previously, several authors proposed using the terms “vasomotor rhinitis” and “non-allergic rhinopathy” concurrently, or even classifying allergic rhinitis under vasomotor rhinitis. This creates discrepancies in interpreting the concepts of “vasomotor rhinitis”, “non-allergic rhinopathy”, and “allergic rhinitis”, hindering a clear understanding of management approaches for the respective patient categories. OBJECTIVE. To analyze available data on the etiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prevention of vasomotor rhinitis. MATERIALS AND METHODS. A search for available information sources, analytical processing, and discussion of the obtained results. RESULTS AND DISCUSSION. Vasomotor rhinitis is a common, yet poorly studied, type of chronic rhinitis that is currently believed to be neurogenic in origin. Several authors use the term “non-allergic rhinopathy” instead of “vasomotor rhinitis”, which complicates the understanding of this issue. Currently, there are no unified international diagnostic criteria for vasomotor rhinitis. In real clinical practice, physicians should perform differential diagnosis between vasomotor and allergic rhinitis (using specific allergodiagnostic methods), as well as exclude infectious rhinitis, drug-induced rhinitis, and chronic rhinosinusitis (using history taking, endoscopy, and other supplementary investigation methods). The majority of patients with vasomotor rhinitis respond adequately to treatment with topical saline solutions, topical antihistamines, corticosteroids, and ipratropium sprays, all of which alleviate rhinitis symptoms. Individuals who are refractory to traditional treatment may undergo therapy with capsaicin, botulinum toxin, and posterior nasal nerve ablation using radiofrequency ablation or cryotherapy. Currently, biological agents and neuromodulatory treatments are at various stages of investigation, focusing on the effect of such targeted therapy on type 2 inflammation, specifically the blockade of interleukin-4 and -13. Despite the encouraging nature of this data for other rhinitis subtypes, their role in vasomotor rhinitis remains unclear. Standardized and highly agreed-upon diagnostic criteria for vasomotor rhinitis must be developed to allow for more precise patient classification through phenotyping, enable targeted therapeutic selection, and establish a reliable evidence base regarding the efficacy and safety of treatment methods for this patient category. CONCLUSIONS. Patients with vasomotor rhinitis often seek medical attention from allergists, otolaryngologists, and physicians of other specialties. Currently, there is no standardized approach to the management of such patients among various specialists. The issue of vasomotor rhinitis remains relevant and poorly understood, but the approaches to managing these patients must be unified.

Rhinologists often encounter a broad spectrum of allergic rhinitis (AR) and nonallergic rhinitis (NAR) patients, who can be variably classified based upon timing and severity of disease. Our understanding of the varied quality of life (QOL) impact in different classifications of rhinitis is limited. Thus a more comprehensive understanding of the impact of rhinitis upon our patients, as measured by both patient reported outcome measures (PROMs) and clinical physiologic measures, as well as unique factors associated with disease severity is needed. A systematic search of databases was performed to identify AR and NAR studies reporting Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), total nasal symptom score (TNSS), or visual analogue scale (VAS) scores, and physiologic measures including peak nasal inspiratory flow (PNIF) and nasal airflow. Relationships between PROMs, physiologic measures, and associated factors (e.g., allergic status, disease duration) were assessed by weighted correlations and meta-regressions. A total of 171 studies reporting on 33,843 patients were included. Symptoms were more severe in AR than NAR on VAS (p<0.001). Classification based upon Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines demonstrated differences in PROM severity. There was no significant correlation between PROMs and demographic factors, comorbidities, or physiologic measures. Meta-regression identified a correlation between worse RQLQ scores and shorter disease duration (r=-0.4, p<0.001). Rhinitic patients have more severe impact upon QOL in the presence of allergy with variable impact upon specific symptom subdomains. PROMs do not correlate with common demographic factors, comorbidities, or physiologic measures of nasal airflow.