Fuad Baroody | University of Chicago (original) (raw)
Papers by Fuad Baroody
Annals of Allergy Asthma & Immunology, Dec 1, 2017
Allergic rhinitis (AR) is a prevalent disorder responsible for a significant and often underappre... more Allergic rhinitis (AR) is a prevalent disorder responsible for a significant and often underappreciated health burden for individuals and society (see Burden of Disease section). Guidelines to improve care for patients with AR have been evolving in an effort to respond to the introduction of new treatment approaches, to address the availability of additional studies that compare treatment options, and to incorporate the use of more standardized, evidence-based medicine methods to analyze data and make recommendations. 1-4 As part of a comprehensive review of
Current Allergy and Asthma Reports, Apr 4, 2014
Acute rhinosinusitis in children is a common disorder that is characterized by some or all of the... more Acute rhinosinusitis in children is a common disorder that is characterized by some or all of the following symptoms: fever, rhinorrhea, nasal congestion, cough, postnasal drainage, and facial pain/headache. It often starts as an upper respiratory tract infection that is complicated by a bacterial infection in which the symptoms worsen, persist, or are particularly severe. The accurate diagnosis of acute rhinosinusitis is challenging because of the overlap of symptoms with other common diseases, heavy reliance on subjective reporting of symptoms by the parents, and difficulties related to the physical examination of the child. Antibiotics are the mainstay of treatment. There is no strong evidence for the use of ancillary therapy. Orbital and intracranial complications may occur and are best treated early and aggressively. This article reviews the diagnosis, pathophysiology, bacteriology, treatment, and complications of acute rhinosinusitis in children.
Laryngoscope, Nov 29, 2019
Objective: The Clinical Assessment Score-15 (CAS-15) has been validated as an office-based assess... more Objective: The Clinical Assessment Score-15 (CAS-15) has been validated as an office-based assessment for pediatric sleep-disordered breathing in otherwise healthy children. Our objective was to determine the generalizability of the CAS-15 in a multi-institutional fashion. Methods: Five hundred and thirty children from 13 sites with suspected sleep-disordered breathing were recruited, and the investigators completed the CAS-15. Based on decisions made in the course of clinical care, investigators recommended overnight polysomnography, observation, medical therapy, and/or surgery. Two hundred and forty-seven subjects had a follow-up CAS-15. Results: Mean age was 5.1 (2.6) years; 54.2% were male; 39.1% were white; and 37.0% were African American. Initial mean (standard deviation [SD]) CAS-15 was 37.3 (12.7), n = 508. Spearman correlation between the initial CAS-15 and the initial apnea-hypopnea index (AHI) was 0.41 (95% confidence interval [CI], 0.29, 0.51), n = 212, P < .001. A receiver-operating characteristic curve predicting positive polysomnography (AHI > 2) had an area under the curve of 0.71 (95% CI, 0.63, 0.80). A score ≥ 32 had a sensitivity of 69.0% (95% CI, 61.7, 75.5), a specificity of 63.4% (95% CI, 47.9, 76.6), a positive predictive value of 88.7% (95% CI, 82.1, 93.1), and a negative predictive value of 32.9% (95% CI, 23.5, 44.0) in predicting positive polysomnography. Among children who underwent surgery, the mean change (SD) score was 30.5 (12.6), n = 201, t = 36.85, P < .001, effect size = 3.1. Conclusion: This study establishes the generalizability of the CAS-15 as a useful office tool for the evaluation of pediatric sleep-disordered breathing.
Journal of Allergy and Clinical Immunology, 2016
It is widely known that patients with chronic rhinosinusitis (CRS) commonly suffer from sleep dis... more It is widely known that patients with chronic rhinosinusitis (CRS) commonly suffer from sleep disruption. Many of these patients have the associated diagnosis of obstructive sleep apnea (OSA). However, little is known about the risk factors for developing OSA in the CRS population. This study aims to identify these risk factors. METHODS: We performed a cohort study of 1004 patients with confirmed diagnostic criteria for CRS. Patient charts were reviewed to identify those with sleep study confirmed OSA. Patient charts were further reviewed for demographic information (age, ethnicity, race, sex, BMI) and medical history including: duration of CRS, presence of nasal polyps, number of endoscopic sinus surgeries, asthma, asthma hospitalizations, asthma ED visits, AERD, allergic rhinitis, eczema, food allergy, GERD, GERD treatment, anosmia and Lund-Mackay score (LMS). RESULTS: 970 patients were included. Logistic or linear regression analyses were performed to correct for BMI. Blacks were at higher risk for OSA (20.7% vs. 10.5% in Latinos and 8% in whites). Higher age was associated with higher risk for OSA. Male gender was a risk factor for OSA (14.2% in Male vs 9.4% Female). OSA was more common in CRSsNP patients. In CRSsNP cases, OSA was associated with GERD and duration of CRS. 25% of male CRSsNP patients above 40 had OSA; this prevalence increased to 40% in male black CRSsNP patients above 40yrs. CONCLUSIONS: Patients with CRS should be screened for OSA. Especially male, black CRSsNP cases who are older than 40 years old.
Proceedings of the American Thoracic Society, 2011
The nose is an integral part of the upper airway and the first contact of the body with inspired ... more The nose is an integral part of the upper airway and the first contact of the body with inspired air. It is located in close proximity to several related airway structures that include the ears, paranasal sinuses, and eyes. It is also closely linked to the lower airway. Multiple lines of evidence support a close interaction and influence of the nose on these contiguous and distant organs via neural reflexes and systemic inflammatory processes. These interactions are reviewed in light of existing evidence.
Current Allergy and Asthma Reports, 2014
Acute rhinosinusitis in children is a common disorder that is characterized by some or all of the... more Acute rhinosinusitis in children is a common disorder that is characterized by some or all of the following symptoms: fever, rhinorrhea, nasal congestion, cough, postnasal drainage, and facial pain/headache. It often starts as an upper respiratory tract infection that is complicated by a bacterial infection in which the symptoms worsen, persist, or are particularly severe. The accurate diagnosis of acute rhinosinusitis is challenging because of the overlap of symptoms with other common diseases, heavy reliance on subjective reporting of symptoms by the parents, and difficulties related to the physical examination of the child. Antibiotics are the mainstay of treatment. There is no strong evidence for the use of ancillary therapy. Orbital and intracranial complications may occur and are best treated early and aggressively. This article reviews the diagnosis, pathophysiology, bacteriology, treatment, and complications of acute rhinosinusitis in children.
American journal of rhinology & allergy
Microbes and allergens can stimulate the nasal mucosa, potentially leading to the development of ... more Microbes and allergens can stimulate the nasal mucosa, potentially leading to the development of acute bacterial rhinosinusitis (ABRS). This study was designed to determine if allergen exposure alters the sinonasal microbiome. We performed a parallel observational study of healthy adults with seasonal allergic rhinitis (SAR; grass or tree, n = 20) or nonallergic subjects (n = 19). Microbiota specimens were obtained by endoscopy from the middle meatus and vestibule before and during the relevant season and were analyzed by terminal restriction fragment length polymorphism analysis. Differences in bacterial microbiota were assessed by standard ecological measures of bacterial diversity. Quality of life and symptom scores were recorded, and nasal lavages for eosinophils were performed. SAR subjects had increased nasal symptoms in season, impaired disease-specific quality of life, and increased nasal eosinophils, compared with no changes in nonallergic subjects. During the season, SAR s...
Journal of Allergy and Clinical Immunology
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 1994
We performed a randomized, double-blind, placebo-controlled cross-over study with two different c... more We performed a randomized, double-blind, placebo-controlled cross-over study with two different concentrations of ipratropium bromide (Atrovent) nasal spray to evaluate its onset and duration of inhibition. Twenty-four subjects with perennial rhinitis participated in the trial. Fifteen minutes to 12 hours after administration of ipratropium bromide (42 or 168 micrograms/nostril) or placebo nasal spray, methacholine challenges were performed and nasal secretion weights measured. After placebo administration the effect of methacholine remained unchanged over the 12-h-period. Both the 42 and 168 micrograms/nostril doses significantly inhibited the nasal hypersecretions induced by methacholine challenge within 15 min of treatment (P < 0.05). The 168 micrograms dose of ipratropium bromide continued to significantly reduce secretion weights through 6 hours, but the effectiveness of the 42 micrograms dose disappeared within 3 h. In addition to having a longer duration, the 168 micrograms/nostril dose produced approximately twice the inhibitory effect of the 42 micrograms dose.
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 1994
We performed a randomized, double-blind, placebo-controlled cross-over study with two different c... more We performed a randomized, double-blind, placebo-controlled cross-over study with two different concentrations of ipratropium bromide (Atrovent) nasal spray to evaluate its onset and duration of inhibition. Twenty-four subjects with perennial rhinitis participated in the trial. Fifteen minutes to 12 hours after administration of ipratropium bromide (42 or 168 micrograms/nostril) or placebo nasal spray, methacholine challenges were performed and nasal secretion weights measured. After placebo administration the effect of methacholine remained unchanged over the 12-h-period. Both the 42 and 168 micrograms/nostril doses significantly inhibited the nasal hypersecretions induced by methacholine challenge within 15 min of treatment (P < 0.05). The 168 micrograms dose of ipratropium bromide continued to significantly reduce secretion weights through 6 hours, but the effectiveness of the 42 micrograms dose disappeared within 3 h. In addition to having a longer duration, the 168 micrograms/nostril dose produced approximately twice the inhibitory effect of the 42 micrograms dose.
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 1994
We performed a randomized, double-blind, placebo-controlled cross-over study with two different c... more We performed a randomized, double-blind, placebo-controlled cross-over study with two different concentrations of ipratropium bromide (Atrovent) nasal spray to evaluate its onset and duration of inhibition. Twenty-four subjects with perennial rhinitis participated in the trial. Fifteen minutes to 12 hours after administration of ipratropium bromide (42 or 168 micrograms/nostril) or placebo nasal spray, methacholine challenges were performed and nasal secretion weights measured. After placebo administration the effect of methacholine remained unchanged over the 12-h-period. Both the 42 and 168 micrograms/nostril doses significantly inhibited the nasal hypersecretions induced by methacholine challenge within 15 min of treatment (P < 0.05). The 168 micrograms dose of ipratropium bromide continued to significantly reduce secretion weights through 6 hours, but the effectiveness of the 42 micrograms dose disappeared within 3 h. In addition to having a longer duration, the 168 micrograms/nostril dose produced approximately twice the inhibitory effect of the 42 micrograms dose.
Archives of Otolaryngology–Head & Neck Surgery, 2011
To determine the effect of intranasal corticosteroid therapy on T-regulatory cells and other infl... more To determine the effect of intranasal corticosteroid therapy on T-regulatory cells and other inflammatory cytokines in adenoid tissues in children with obstructive sleep apnea syndrome.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Feb 1, 2018
Objective To develop a clinical consensus statement on the use of sinus ostial dilation (SOD) of ... more Objective To develop a clinical consensus statement on the use of sinus ostial dilation (SOD) of the paranasal sinuses. Methods An expert panel of otolaryngologists was assembled to represent general otolaryngology and relevant subspecialty societies. The target population is adults 18 years or older with chronic or recurrent rhinosinusitis (with or without nasal polyps, with or without prior sinus surgery) for whom SOD is being recommended, defined as endoscopic use of a balloon device to enlarge or open the outflow tracts of the maxillary, frontal, or sphenoid sinuses, as a standalone procedure or with endoscopic surgery. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus. Results After 3 iterative Delphi method surveys, 13 statements met the standardized definition of consensus while 45 statements did not. The clinical statements were grouped into 3 categories for presentation and discussion: (1) pa...
American Journal of Respiratory and Critical Care Medicine, 2001
We previously showed that individuals with seasonal allergic rhinitis (SAR) had a reduced ability... more We previously showed that individuals with seasonal allergic rhinitis (SAR) had a reduced ability to condition air, which was improved by inflammation. We hypothesized that individuals with perennial allergic rhinitis (PAR) would condition air like SAR with inflammation. Because individuals with asthma usually have inflammation in the nose, we hypothesized that they would condition air like individuals with PAR. We performed a prospective, parallel study on 15 normal subjects, 15 subjects with SAR outside their allergy season, 15 subjects with PAR, and 15 subjects with asthma. Cold, dry air (CDA) was delivered to the nose and the temperature and humidity of the air were measured before entering and after exiting the nasal cavity. The total water gradient (TWG) was calculated and represents the nasal conditioning capacity. The TWG in the SAR group was significantly lower than that in normal subjects. There were no significant differences in TWG between the PAR and normal groups. Subjects with asthma had a significantly lower TWG than did normal subjects. There was a significant negative correlation between TWG and Aas score in the group with asthma (r(s) = -0.8, p = 0.0007). Our data show that subjects with asthma have a reduced ability of the nose to condition CDA compared with normal subjects, but which is similar to SAR out of season.
Journal of Applied …, 1993
To better understand the secretory response of the nasal mucosa, we must be able to accurately me... more To better understand the secretory response of the nasal mucosa, we must be able to accurately measure its physiological response. To this end, we developed a localized challenge technique using paper disks to stimulate the mucosa on one side and measure secretions from both sides to study both direct and reflex responses. Both methacholine and histamine induced a dose-dependent increase in secretion weights on the challenge side, whereas only histamine induced a contralateral reflex. Repeated stimulation with histamine, but not methacholine, resulted in tachyphylaxis. Pretreatment with atropine resulted in inhibition of the contralateral secretory response to histamine and the ipsilateral response to methacholine with only partial inhibition of the ipsilateral histamine response. Terfenadine pretreatment resulted in the complete inhibition of both the ipsilateral and contralateral responses to histamine with no effect on methacholine-induced secretions. Ipsilaterally applied lidocaine had no effect on the histamine response but, when applied contralaterally, partially inhibited that response. Topical diphenhydramine applied ipsilaterally led to significant inhibition of the ipsilateral and contralateral secretory responses to histamine but had no effect when applied contralaterally. We conclude that methacholine and histamine have different effects on the nasal mucosa. We speculate that methacholine stimulates glands directly, whereas histamine includes both direct and neurogenic stimulation.
Journal of Applied …, 1993
To better understand the secretory response of the nasal mucosa, we must be able to accurately me... more To better understand the secretory response of the nasal mucosa, we must be able to accurately measure its physiological response. To this end, we developed a localized challenge technique using paper disks to stimulate the mucosa on one side and measure secretions from both sides to study both direct and reflex responses. Both methacholine and histamine induced a dose-dependent increase in secretion weights on the challenge side, whereas only histamine induced a contralateral reflex. Repeated stimulation with histamine, but not methacholine, resulted in tachyphylaxis. Pretreatment with atropine resulted in inhibition of the contralateral secretory response to histamine and the ipsilateral response to methacholine with only partial inhibition of the ipsilateral histamine response. Terfenadine pretreatment resulted in the complete inhibition of both the ipsilateral and contralateral responses to histamine with no effect on methacholine-induced secretions. Ipsilaterally applied lidocaine had no effect on the histamine response but, when applied contralaterally, partially inhibited that response. Topical diphenhydramine applied ipsilaterally led to significant inhibition of the ipsilateral and contralateral secretory responses to histamine but had no effect when applied contralaterally. We conclude that methacholine and histamine have different effects on the nasal mucosa. We speculate that methacholine stimulates glands directly, whereas histamine includes both direct and neurogenic stimulation.
Archives of Otolaryngology–Head & Neck Surgery, 2011
To determine the effect of intranasal corticosteroid therapy on T-regulatory cells and other infl... more To determine the effect of intranasal corticosteroid therapy on T-regulatory cells and other inflammatory cytokines in adenoid tissues in children with obstructive sleep apnea syndrome.
American Journal of Respiratory and Critical Care Medicine, 1997
Studying the inflammatory response that follows the early response to nasal challenge with antige... more Studying the inflammatory response that follows the early response to nasal challenge with antigen provides a better understanding of allergic rhinitis than just studying the immediate (early) response. Nine allergic volunteers were challenged unilaterally with antigen-containing discs, and bilateral changes in physiologic responses as well as in the concentration of histamine in nasal secretions were measured for 11 h. We found significant immediate increases in symptoms, sneezes, ipsilateral nasal airway resistance, and ipsilateral histamine in the early phase response. Two-thirds of the allergen-challenged volunteers showed increases in physiologic parameters or histamine in the hours after allergen challenge. The pooled data of all subjects exhibited significant increases in bilateral nasal airway resistance and in ipsilateral and contralateral histamine, hours after unilateral provocation. These responses differed significantly from control subjects. In another group of 11 volunteers challenged ipsilaterally with antigen, the number of basophils increased both on the side of challenge and on the contralateral side. The magnitude of the increase on the ipsilateral side correlated with the increase on the contralateral side (r(s) = 0.72). The basophils are the most likely source of the contralateral increase in histamine as they are on the ipsilateral side. Although the mechanisms underlying this contralateral increase in basophils and histamine are not known, we speculate that delayed, neurogenic responses play a contributory role.
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 1994
We performed a randomized, double-blind, placebo-controlled cross-over study with two different c... more We performed a randomized, double-blind, placebo-controlled cross-over study with two different concentrations of ipratropium bromide (Atrovent) nasal spray to evaluate its onset and duration of inhibition. Twenty-four subjects with perennial rhinitis participated in the trial. Fifteen minutes to 12 hours after administration of ipratropium bromide (42 or 168 micrograms/nostril) or placebo nasal spray, methacholine challenges were performed and nasal secretion weights measured. After placebo administration the effect of methacholine remained unchanged over the 12-h-period. Both the 42 and 168 micrograms/nostril doses significantly inhibited the nasal hypersecretions induced by methacholine challenge within 15 min of treatment (P < 0.05). The 168 micrograms dose of ipratropium bromide continued to significantly reduce secretion weights through 6 hours, but the effectiveness of the 42 micrograms dose disappeared within 3 h. In addition to having a longer duration, the 168 micrograms/nostril dose produced approximately twice the inhibitory effect of the 42 micrograms dose.
Annals of Allergy Asthma & Immunology, Dec 1, 2017
Allergic rhinitis (AR) is a prevalent disorder responsible for a significant and often underappre... more Allergic rhinitis (AR) is a prevalent disorder responsible for a significant and often underappreciated health burden for individuals and society (see Burden of Disease section). Guidelines to improve care for patients with AR have been evolving in an effort to respond to the introduction of new treatment approaches, to address the availability of additional studies that compare treatment options, and to incorporate the use of more standardized, evidence-based medicine methods to analyze data and make recommendations. 1-4 As part of a comprehensive review of
Current Allergy and Asthma Reports, Apr 4, 2014
Acute rhinosinusitis in children is a common disorder that is characterized by some or all of the... more Acute rhinosinusitis in children is a common disorder that is characterized by some or all of the following symptoms: fever, rhinorrhea, nasal congestion, cough, postnasal drainage, and facial pain/headache. It often starts as an upper respiratory tract infection that is complicated by a bacterial infection in which the symptoms worsen, persist, or are particularly severe. The accurate diagnosis of acute rhinosinusitis is challenging because of the overlap of symptoms with other common diseases, heavy reliance on subjective reporting of symptoms by the parents, and difficulties related to the physical examination of the child. Antibiotics are the mainstay of treatment. There is no strong evidence for the use of ancillary therapy. Orbital and intracranial complications may occur and are best treated early and aggressively. This article reviews the diagnosis, pathophysiology, bacteriology, treatment, and complications of acute rhinosinusitis in children.
Laryngoscope, Nov 29, 2019
Objective: The Clinical Assessment Score-15 (CAS-15) has been validated as an office-based assess... more Objective: The Clinical Assessment Score-15 (CAS-15) has been validated as an office-based assessment for pediatric sleep-disordered breathing in otherwise healthy children. Our objective was to determine the generalizability of the CAS-15 in a multi-institutional fashion. Methods: Five hundred and thirty children from 13 sites with suspected sleep-disordered breathing were recruited, and the investigators completed the CAS-15. Based on decisions made in the course of clinical care, investigators recommended overnight polysomnography, observation, medical therapy, and/or surgery. Two hundred and forty-seven subjects had a follow-up CAS-15. Results: Mean age was 5.1 (2.6) years; 54.2% were male; 39.1% were white; and 37.0% were African American. Initial mean (standard deviation [SD]) CAS-15 was 37.3 (12.7), n = 508. Spearman correlation between the initial CAS-15 and the initial apnea-hypopnea index (AHI) was 0.41 (95% confidence interval [CI], 0.29, 0.51), n = 212, P < .001. A receiver-operating characteristic curve predicting positive polysomnography (AHI > 2) had an area under the curve of 0.71 (95% CI, 0.63, 0.80). A score ≥ 32 had a sensitivity of 69.0% (95% CI, 61.7, 75.5), a specificity of 63.4% (95% CI, 47.9, 76.6), a positive predictive value of 88.7% (95% CI, 82.1, 93.1), and a negative predictive value of 32.9% (95% CI, 23.5, 44.0) in predicting positive polysomnography. Among children who underwent surgery, the mean change (SD) score was 30.5 (12.6), n = 201, t = 36.85, P < .001, effect size = 3.1. Conclusion: This study establishes the generalizability of the CAS-15 as a useful office tool for the evaluation of pediatric sleep-disordered breathing.
Journal of Allergy and Clinical Immunology, 2016
It is widely known that patients with chronic rhinosinusitis (CRS) commonly suffer from sleep dis... more It is widely known that patients with chronic rhinosinusitis (CRS) commonly suffer from sleep disruption. Many of these patients have the associated diagnosis of obstructive sleep apnea (OSA). However, little is known about the risk factors for developing OSA in the CRS population. This study aims to identify these risk factors. METHODS: We performed a cohort study of 1004 patients with confirmed diagnostic criteria for CRS. Patient charts were reviewed to identify those with sleep study confirmed OSA. Patient charts were further reviewed for demographic information (age, ethnicity, race, sex, BMI) and medical history including: duration of CRS, presence of nasal polyps, number of endoscopic sinus surgeries, asthma, asthma hospitalizations, asthma ED visits, AERD, allergic rhinitis, eczema, food allergy, GERD, GERD treatment, anosmia and Lund-Mackay score (LMS). RESULTS: 970 patients were included. Logistic or linear regression analyses were performed to correct for BMI. Blacks were at higher risk for OSA (20.7% vs. 10.5% in Latinos and 8% in whites). Higher age was associated with higher risk for OSA. Male gender was a risk factor for OSA (14.2% in Male vs 9.4% Female). OSA was more common in CRSsNP patients. In CRSsNP cases, OSA was associated with GERD and duration of CRS. 25% of male CRSsNP patients above 40 had OSA; this prevalence increased to 40% in male black CRSsNP patients above 40yrs. CONCLUSIONS: Patients with CRS should be screened for OSA. Especially male, black CRSsNP cases who are older than 40 years old.
Proceedings of the American Thoracic Society, 2011
The nose is an integral part of the upper airway and the first contact of the body with inspired ... more The nose is an integral part of the upper airway and the first contact of the body with inspired air. It is located in close proximity to several related airway structures that include the ears, paranasal sinuses, and eyes. It is also closely linked to the lower airway. Multiple lines of evidence support a close interaction and influence of the nose on these contiguous and distant organs via neural reflexes and systemic inflammatory processes. These interactions are reviewed in light of existing evidence.
Current Allergy and Asthma Reports, 2014
Acute rhinosinusitis in children is a common disorder that is characterized by some or all of the... more Acute rhinosinusitis in children is a common disorder that is characterized by some or all of the following symptoms: fever, rhinorrhea, nasal congestion, cough, postnasal drainage, and facial pain/headache. It often starts as an upper respiratory tract infection that is complicated by a bacterial infection in which the symptoms worsen, persist, or are particularly severe. The accurate diagnosis of acute rhinosinusitis is challenging because of the overlap of symptoms with other common diseases, heavy reliance on subjective reporting of symptoms by the parents, and difficulties related to the physical examination of the child. Antibiotics are the mainstay of treatment. There is no strong evidence for the use of ancillary therapy. Orbital and intracranial complications may occur and are best treated early and aggressively. This article reviews the diagnosis, pathophysiology, bacteriology, treatment, and complications of acute rhinosinusitis in children.
American journal of rhinology & allergy
Microbes and allergens can stimulate the nasal mucosa, potentially leading to the development of ... more Microbes and allergens can stimulate the nasal mucosa, potentially leading to the development of acute bacterial rhinosinusitis (ABRS). This study was designed to determine if allergen exposure alters the sinonasal microbiome. We performed a parallel observational study of healthy adults with seasonal allergic rhinitis (SAR; grass or tree, n = 20) or nonallergic subjects (n = 19). Microbiota specimens were obtained by endoscopy from the middle meatus and vestibule before and during the relevant season and were analyzed by terminal restriction fragment length polymorphism analysis. Differences in bacterial microbiota were assessed by standard ecological measures of bacterial diversity. Quality of life and symptom scores were recorded, and nasal lavages for eosinophils were performed. SAR subjects had increased nasal symptoms in season, impaired disease-specific quality of life, and increased nasal eosinophils, compared with no changes in nonallergic subjects. During the season, SAR s...
Journal of Allergy and Clinical Immunology
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 1994
We performed a randomized, double-blind, placebo-controlled cross-over study with two different c... more We performed a randomized, double-blind, placebo-controlled cross-over study with two different concentrations of ipratropium bromide (Atrovent) nasal spray to evaluate its onset and duration of inhibition. Twenty-four subjects with perennial rhinitis participated in the trial. Fifteen minutes to 12 hours after administration of ipratropium bromide (42 or 168 micrograms/nostril) or placebo nasal spray, methacholine challenges were performed and nasal secretion weights measured. After placebo administration the effect of methacholine remained unchanged over the 12-h-period. Both the 42 and 168 micrograms/nostril doses significantly inhibited the nasal hypersecretions induced by methacholine challenge within 15 min of treatment (P < 0.05). The 168 micrograms dose of ipratropium bromide continued to significantly reduce secretion weights through 6 hours, but the effectiveness of the 42 micrograms dose disappeared within 3 h. In addition to having a longer duration, the 168 micrograms/nostril dose produced approximately twice the inhibitory effect of the 42 micrograms dose.
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 1994
We performed a randomized, double-blind, placebo-controlled cross-over study with two different c... more We performed a randomized, double-blind, placebo-controlled cross-over study with two different concentrations of ipratropium bromide (Atrovent) nasal spray to evaluate its onset and duration of inhibition. Twenty-four subjects with perennial rhinitis participated in the trial. Fifteen minutes to 12 hours after administration of ipratropium bromide (42 or 168 micrograms/nostril) or placebo nasal spray, methacholine challenges were performed and nasal secretion weights measured. After placebo administration the effect of methacholine remained unchanged over the 12-h-period. Both the 42 and 168 micrograms/nostril doses significantly inhibited the nasal hypersecretions induced by methacholine challenge within 15 min of treatment (P < 0.05). The 168 micrograms dose of ipratropium bromide continued to significantly reduce secretion weights through 6 hours, but the effectiveness of the 42 micrograms dose disappeared within 3 h. In addition to having a longer duration, the 168 micrograms/nostril dose produced approximately twice the inhibitory effect of the 42 micrograms dose.
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 1994
We performed a randomized, double-blind, placebo-controlled cross-over study with two different c... more We performed a randomized, double-blind, placebo-controlled cross-over study with two different concentrations of ipratropium bromide (Atrovent) nasal spray to evaluate its onset and duration of inhibition. Twenty-four subjects with perennial rhinitis participated in the trial. Fifteen minutes to 12 hours after administration of ipratropium bromide (42 or 168 micrograms/nostril) or placebo nasal spray, methacholine challenges were performed and nasal secretion weights measured. After placebo administration the effect of methacholine remained unchanged over the 12-h-period. Both the 42 and 168 micrograms/nostril doses significantly inhibited the nasal hypersecretions induced by methacholine challenge within 15 min of treatment (P < 0.05). The 168 micrograms dose of ipratropium bromide continued to significantly reduce secretion weights through 6 hours, but the effectiveness of the 42 micrograms dose disappeared within 3 h. In addition to having a longer duration, the 168 micrograms/nostril dose produced approximately twice the inhibitory effect of the 42 micrograms dose.
Archives of Otolaryngology–Head & Neck Surgery, 2011
To determine the effect of intranasal corticosteroid therapy on T-regulatory cells and other infl... more To determine the effect of intranasal corticosteroid therapy on T-regulatory cells and other inflammatory cytokines in adenoid tissues in children with obstructive sleep apnea syndrome.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Feb 1, 2018
Objective To develop a clinical consensus statement on the use of sinus ostial dilation (SOD) of ... more Objective To develop a clinical consensus statement on the use of sinus ostial dilation (SOD) of the paranasal sinuses. Methods An expert panel of otolaryngologists was assembled to represent general otolaryngology and relevant subspecialty societies. The target population is adults 18 years or older with chronic or recurrent rhinosinusitis (with or without nasal polyps, with or without prior sinus surgery) for whom SOD is being recommended, defined as endoscopic use of a balloon device to enlarge or open the outflow tracts of the maxillary, frontal, or sphenoid sinuses, as a standalone procedure or with endoscopic surgery. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus. Results After 3 iterative Delphi method surveys, 13 statements met the standardized definition of consensus while 45 statements did not. The clinical statements were grouped into 3 categories for presentation and discussion: (1) pa...
American Journal of Respiratory and Critical Care Medicine, 2001
We previously showed that individuals with seasonal allergic rhinitis (SAR) had a reduced ability... more We previously showed that individuals with seasonal allergic rhinitis (SAR) had a reduced ability to condition air, which was improved by inflammation. We hypothesized that individuals with perennial allergic rhinitis (PAR) would condition air like SAR with inflammation. Because individuals with asthma usually have inflammation in the nose, we hypothesized that they would condition air like individuals with PAR. We performed a prospective, parallel study on 15 normal subjects, 15 subjects with SAR outside their allergy season, 15 subjects with PAR, and 15 subjects with asthma. Cold, dry air (CDA) was delivered to the nose and the temperature and humidity of the air were measured before entering and after exiting the nasal cavity. The total water gradient (TWG) was calculated and represents the nasal conditioning capacity. The TWG in the SAR group was significantly lower than that in normal subjects. There were no significant differences in TWG between the PAR and normal groups. Subjects with asthma had a significantly lower TWG than did normal subjects. There was a significant negative correlation between TWG and Aas score in the group with asthma (r(s) = -0.8, p = 0.0007). Our data show that subjects with asthma have a reduced ability of the nose to condition CDA compared with normal subjects, but which is similar to SAR out of season.
Journal of Applied …, 1993
To better understand the secretory response of the nasal mucosa, we must be able to accurately me... more To better understand the secretory response of the nasal mucosa, we must be able to accurately measure its physiological response. To this end, we developed a localized challenge technique using paper disks to stimulate the mucosa on one side and measure secretions from both sides to study both direct and reflex responses. Both methacholine and histamine induced a dose-dependent increase in secretion weights on the challenge side, whereas only histamine induced a contralateral reflex. Repeated stimulation with histamine, but not methacholine, resulted in tachyphylaxis. Pretreatment with atropine resulted in inhibition of the contralateral secretory response to histamine and the ipsilateral response to methacholine with only partial inhibition of the ipsilateral histamine response. Terfenadine pretreatment resulted in the complete inhibition of both the ipsilateral and contralateral responses to histamine with no effect on methacholine-induced secretions. Ipsilaterally applied lidocaine had no effect on the histamine response but, when applied contralaterally, partially inhibited that response. Topical diphenhydramine applied ipsilaterally led to significant inhibition of the ipsilateral and contralateral secretory responses to histamine but had no effect when applied contralaterally. We conclude that methacholine and histamine have different effects on the nasal mucosa. We speculate that methacholine stimulates glands directly, whereas histamine includes both direct and neurogenic stimulation.
Journal of Applied …, 1993
To better understand the secretory response of the nasal mucosa, we must be able to accurately me... more To better understand the secretory response of the nasal mucosa, we must be able to accurately measure its physiological response. To this end, we developed a localized challenge technique using paper disks to stimulate the mucosa on one side and measure secretions from both sides to study both direct and reflex responses. Both methacholine and histamine induced a dose-dependent increase in secretion weights on the challenge side, whereas only histamine induced a contralateral reflex. Repeated stimulation with histamine, but not methacholine, resulted in tachyphylaxis. Pretreatment with atropine resulted in inhibition of the contralateral secretory response to histamine and the ipsilateral response to methacholine with only partial inhibition of the ipsilateral histamine response. Terfenadine pretreatment resulted in the complete inhibition of both the ipsilateral and contralateral responses to histamine with no effect on methacholine-induced secretions. Ipsilaterally applied lidocaine had no effect on the histamine response but, when applied contralaterally, partially inhibited that response. Topical diphenhydramine applied ipsilaterally led to significant inhibition of the ipsilateral and contralateral secretory responses to histamine but had no effect when applied contralaterally. We conclude that methacholine and histamine have different effects on the nasal mucosa. We speculate that methacholine stimulates glands directly, whereas histamine includes both direct and neurogenic stimulation.
Archives of Otolaryngology–Head & Neck Surgery, 2011
To determine the effect of intranasal corticosteroid therapy on T-regulatory cells and other infl... more To determine the effect of intranasal corticosteroid therapy on T-regulatory cells and other inflammatory cytokines in adenoid tissues in children with obstructive sleep apnea syndrome.
American Journal of Respiratory and Critical Care Medicine, 1997
Studying the inflammatory response that follows the early response to nasal challenge with antige... more Studying the inflammatory response that follows the early response to nasal challenge with antigen provides a better understanding of allergic rhinitis than just studying the immediate (early) response. Nine allergic volunteers were challenged unilaterally with antigen-containing discs, and bilateral changes in physiologic responses as well as in the concentration of histamine in nasal secretions were measured for 11 h. We found significant immediate increases in symptoms, sneezes, ipsilateral nasal airway resistance, and ipsilateral histamine in the early phase response. Two-thirds of the allergen-challenged volunteers showed increases in physiologic parameters or histamine in the hours after allergen challenge. The pooled data of all subjects exhibited significant increases in bilateral nasal airway resistance and in ipsilateral and contralateral histamine, hours after unilateral provocation. These responses differed significantly from control subjects. In another group of 11 volunteers challenged ipsilaterally with antigen, the number of basophils increased both on the side of challenge and on the contralateral side. The magnitude of the increase on the ipsilateral side correlated with the increase on the contralateral side (r(s) = 0.72). The basophils are the most likely source of the contralateral increase in histamine as they are on the ipsilateral side. Although the mechanisms underlying this contralateral increase in basophils and histamine are not known, we speculate that delayed, neurogenic responses play a contributory role.
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 1994
We performed a randomized, double-blind, placebo-controlled cross-over study with two different c... more We performed a randomized, double-blind, placebo-controlled cross-over study with two different concentrations of ipratropium bromide (Atrovent) nasal spray to evaluate its onset and duration of inhibition. Twenty-four subjects with perennial rhinitis participated in the trial. Fifteen minutes to 12 hours after administration of ipratropium bromide (42 or 168 micrograms/nostril) or placebo nasal spray, methacholine challenges were performed and nasal secretion weights measured. After placebo administration the effect of methacholine remained unchanged over the 12-h-period. Both the 42 and 168 micrograms/nostril doses significantly inhibited the nasal hypersecretions induced by methacholine challenge within 15 min of treatment (P < 0.05). The 168 micrograms dose of ipratropium bromide continued to significantly reduce secretion weights through 6 hours, but the effectiveness of the 42 micrograms dose disappeared within 3 h. In addition to having a longer duration, the 168 micrograms/nostril dose produced approximately twice the inhibitory effect of the 42 micrograms dose.