Exhaled and nasal NO levels in allergic rhinitis: relation to sensitization, pollen season and bronchial hyperresponsiveness (original) (raw)
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Iranian journal of allergy, asthma, and immunology, 2011
Allergic rhinitis and asthma share common epidemiological features and inflammatory processes. The aim of the present study was to document the influence of natural allergen exposure in exhaled NO (eNO) and in spirometric parameters of patients with seasonal allergic rhinitis(SAR) and to investigate the differences among subjects with positive versus negative bronchial provocation to metacholine(BPMch).Twenty-six non-smoking patients (13F/13M; mean age 28.4ys) with a documented history of SAR, 15 healthy, non-atopic(6F/9M; mean age 37.1ys) and 6 non-symptomatic atopic subjects (3F/3M; mean age 36.5ys) were studied. At the first visit during pollen season each subject filled symptom-score card, underwent eNO and nasal NO (nNO) measurements and spirometry. BPMch was performed within the next 10 days. At the second visit out of pollen season, all measurements but BPMch were repeated. Control subjects underwent eNO and nNO measurements.eNO was significantly increased during pollen seaso...
Exhaled nitric oxide in seasonal allergic rhinitis: influence of pollen season and therapy
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 2001
Exhaled nitric oxide (eNO) has been proposed as a potential indirect marker of lower airway inflammation in asthma. To investigate the existence of lower airways inflammation in allergic rhinitis eNO measurements were performed in 32 patients with symptomatic and asymptomatic seasonal allergic rhinitis early in and out of pollen seasons and in 80 healthy volunteers. To further define how exhaled NO is modified by therapy, NO levels were detected following 1-month treatment with either inhaled steroids or nonsteroids therapy with nedocromil. Exhaled NO (mean^SE) was significantly elevated in patients with seasonal allergic rhinitis with and without symptoms (24.2 1 2.5 and 13.9 1 2.9 ppb, respectively) as compared to healthy volunteers (4.5 1 0.3 ppb) both in and out of pollen season (21.2 1 2.1 and 9.0 1 1.4 p.p.b., respectively) with a higher increase during the allergen exposure in season. Higher levels of exhaled NO were detected in patients with symptoms, either from the upper or lower airways, and with bronchial hyperreactivity. The increased exhaled NO in symptomatic patients was reduced only by inhaled steroids and not by nedocromil. These findings possibly suggest the existence of lower airway inflammation in both symptomatic and asymptomatic patients with seasonal allergic rhinitis in and out of pollen season. Thus, exhaled NO may be used as a non-invasive index for early detection of lower airway inflammation and for monitoring the optional treatment in patients with seasonal allergic rhinitis.
Lung India, 2014
standardized for supporting the diagnosis in cases of eosinophilic inflammation of airways, bronchial hyperreactivity and asthma. FE NO levels have been higher in atopic than non-atopic bronchial asthma patients and some studies also reported that healthy atopic subjects without symptoms or signs of airway disorders have higher FE NO levels than non-atopic subjects. Similarly the effect of clinical atopy, with atopic cases having higher levels as compared to non-atopic cases. To the best of our knowledge, the literature on exhaled breath and nasal nitric oxide from India is lacking. Hence, this study was undertaken to answer the question about the relationship between the noninvasive methods of nitric oxide measurements in bronchial asthma and allergic rhinitis and their correlation with atopic profile of Indian population.
Background: Concentration of nitric oxide in exhaled air (FeNO) was revealed to decrease as a result of immunotherapy. However, individuals who are exposed to environmental allergens are characterized by elevated values of FeNO. The aim of this study was to analyze the effects of subcutaneous immunotherapy (SCIT) on the dynamics of FeNO determined during consecutive pollination seasons. Methods: This study, performed between 2005 and 2008, included 41 patients with confirmed sensitivity to grass pollens and predominating symptoms of seasonal allergic rhinitis, randomly assigned to desensitization by preseasonal or maintenance SCIT. FeNO was measured prior to and during each pollen season (November– January and May–July, respectively). The results were conferred to data on grass pollination intensity in 2006– 2008 (air concentration of grass pollen grains, seasonal number of days when air concentration of grass pollen reached at least 50 grains per 1m3). Results: Median content of FeNO in exhaled air was significantly higher in 2007 compared to 2006 and 2008 pollen seasons. During 2007 and 2008 pollen seasons, significant increase in FeNO was observed compared to the respective preseasonal values. Median number of days with air concentration of grass pollen ‡ 50 grains per 1m3 of air during 4 weeks preceding seasonal FeNO measurement was significantly higher in 2007, corresponding to higher FeNO value recorded during this pollen season. However, no significant correlation was observed between seasonal number of days with ‡ 50 grass pollen grains per 1m3 of air and FeNO in exhaled air (r¼0.09, p¼0.362). Conclusions: Most seasonal allergic rhinitis patients show physiological levels of FeNO prior to the pollen seasons and a marked increase in this parameter, probably proportional to pollination intensity, is observed within the seasons. ISRCTN Registry: ISRCTN86562422 JOURNAL OF AEROSOL MEDICINE AND PULMONARY DRUG DELIVERY, Volume 25, Number 3, 2012 DOI: 10.1089/jamp.2011.0917
Exhaled nitric oxide: relation to sensitization and respiratory symptoms
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 2004
Background Conflicting data have been presented as to whether nitric oxide (NO) in exhaled air is merely reflecting atopy rather than airway inflammation. Objective To investigate the relationship between exhaled NO (eNO) and nasal NO (nNO), respiratory symptoms, and atopy, in the context of a cross-sectional study of the respiratory health of bleachery workers. Methods Two hundred and forty-six non-smoking bleachery and paper-mill workers answered a questionnaire and were examined by measurements of eNO and nNO and spirometry, outside the pollen season. Blood samples were collected and analysed for specific IgE against common aeroallergens (birch, timothy, cat and house dust mite). Atopy was defined as a positive Phadiatop TM test. Results The atopic and the non-atopic subjects without asthma or rhinitis had similar levels of eNO. Subjects reporting asthma or rhinitis who were also sensitized to perennial allergens had higher levels of eNO, whereas those sensitized to only seasonal allergens had similar eNO levels as nonatopic subjects with asthma or rhinitis. In multiple linear regression models adjusted for nNO, eNO was associated with asthma and sensitization to perennial allergens. Conclusion The results indicate that only atopic subjects who have recently been exposed to the relevant allergen have elevated levels of eNO. Atopic subjects who are not being exposed to a relevant allergen or have never experienced symptoms of asthma or rhinitis show normal eNO. These data indicate that eNO relates to airway inflammation in atopic subjects.
2013
standardized for supporting the diagnosis in cases of eosinophilic inflammation of airways, bronchial hyperreactivity and asthma. FE NO levels have been higher in atopic than non-atopic bronchial asthma patients and some studies also reported that healthy atopic subjects without symptoms or signs of airway disorders have higher FE NO levels than non-atopic subjects. Similarly the effect of clinical atopy, with atopic cases having higher levels as compared to non-atopic cases. To the best of our knowledge, the literature on exhaled breath and nasal nitric oxide from India is lacking. Hence, this study was undertaken to answer the question about the relationship between the noninvasive methods of nitric oxide measurements in bronchial asthma and allergic rhinitis and their correlation with atopic profile of Indian population.
Journal of Allergy and Clinical Immunology, 1997
Nitric oxide (NO) is produced in large amounts in the noses of normal individuals. We have measured NO by chemiluminescence in the noses and exhaled air of subjects with symptomatic allergic rhinitis, some of whom had concomitant asthma, during the pollen season and compared this with values measured in normal subjects and in patients treated with nasal and~or inhaled glucocorticoids. We found that nasal levels of NO were significantly (p < 0.001) elevated in patients with untreated rhinitis (1527 +-87 ppb, n = 12) compared with normal individuals (996 +_ 39 ppb, n = 46) or subjects treated with nasal steroids (681 +-34 ppb, n = 10), whereas exhaled NO in patients with untreated rhinitis was similar to that in normal subjects (10 +_ 2 ppb vs 7 + 0.6 ppb, respectively). In five subjects who were nasally challenged with allergen, there was a significant decrease in nasal NO 1 hour after challenge, and this was significantly correlated with increased rhinitis symptoms. In patients with rhinitis and concomitant asthma, nasal NO was also significantly elevated (1441 +_ 76 ppb, n = 16) but not when they were treated with nasal or inhaled steroids; whereas exhaled NO was elevated in untreated patients and in patients treated with nasal, but not inhaled, steroids. Our data suggest that the increase in exhaled NO in patients with allergic rhinitis is likely to be due to increased local production, caused by long-term exposure to allergen, which is suppressed by locally administered steroids. Measurement of nasal NO may be useful to study the inflammatory response in rhinitis and its response to antiinflammatory treatments. (J AUergy Clin Immunol 1997;99:58-64.)
Allergy, 2007
Allergic rhinitis (AR) is an IgE-triggered chronic inflammatory disorder of the upper airways with pathophysiological and immunological links to allergic asthma (1). Recent studies providing evidence of systemic cross-talk between upper and lower airway compartments, have resulted in the concepts of Ôallergic airway diseaseÕ or Ôcombined allergic rhinitis and asthma syndromeÕ (CARAS) (2). The hallmark of CARAS is chronic airway inflammation, mainly characterized by mast cells, eosinophils, and their pro-inflammatory products (3). Historically, airway biopsies have been regarded as the gold standard for the sampling of the allergic airway inflammation. However, the applicability of invasive methods is limited for repeated sampling, such as in clinical monitoring or intervention trials. In addition, biopsies are limited to a very small part of the airways. Therefore, several less or noninvasive methodologies are being developed, some of which have been validated (4). Nitric oxide (NO) is a gaseous molecule synthesized in the respiratory compartment by NO-synthases (NOS) and can be detected in exhaled air of various species
Exhaled nitric oxide and its relationship to airway responsiveness and atopy in asthma
Respiratory Medicine, 1999
Exhaled nitric oxide (NO) has attracted increasing interest as a non-invasive marker of airway inflammation. The purpose of this study was to determine whether exhaled nitric oxide in subjects with asthma varied according to their atopic status and to examine its correlation with airway hyperresponsiveness and lung function measurements. Forty patients with asthma and 13 controls participated in the study. Nitric oxide was measured on three occasions with intervals of at least 3 days, using a chemiluminescence method. Airway responsiveness was assessed with methacholine challenge and lung function measurements were made. All subjects recorded peak expiratory flow and kept a symptom diary during a 17-day period. There was no significant difference in lung function measurements, peak expiratory flow or symptom score between the two asthma groups. Atopic patients with asthma had a significantly higher mean amount of exhaled NO than non-atopic subjects with asthma (162 &-68 VS. 113*55 nl min-'; P = 0.03) and the control group (88 + 52 nl min-'; P = 0.004). No significant difference was found in the amount of exhaled NO between non-atopic patients with asthma and the controls. In atopic subjects with asthma the mean exhaled NO was significantly correlated to the dose-response slope for methacholine (r =-0.52; P=O*O2), while no such correlation was found in the non-atopic group. In conclusion; in this study, atopic subjects with asthma had higher levels of exhaled NO than non-atopic subjects. Atopic status should be taken into account when measuring levels of exhaled NO in subjects with asthma.
Exhaled and nasal nitric oxide is increased in laboratory animal allergy
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 1998
Background Allergens from rats, mice, guinea pigs or rabbits cause up to 30% of exposed persons to develop specific immunoglobulin E (IgE) responses. Laboratory animal allergy (LAA) is among the highest occupational risks for asthma in the UK. Elevated levels of nitric oxide (NO) are found in exhaled breath in asthma. In LAA symptoms may progress from conjunctivitis, rhinitis to asthma. Health surveillance aims to detect early sensitization. Objective To assess whether an association exists between LAA and exhaled NO. Methods A cross-sectional study was performed in 39 laboratory workers undergoing LAA health surveillance. Volunteers completed two health questionnaires, had skin-prick tests, spirometry, total IgE and RAST tests. Exhaled and nasal NO was measured by chemiluminescence analyser (LR2000, Logan Research, Rochester, UK). Results There were 23 asymptomatic subjects (mean age 29.53 yearss) and 16 symptomatic subjects (29.63 yearss, P ¼ 0.95); 9 early LAA, seven LAA asthma. Exhaled NO was raised in those with LAA symptoms 17.97 ppb Ϯ 1.24 (mean Ϯ SEM) compared with asymptomatics 6.08 ppb Ϯ 1.15, P < 0.05. A trend of increased NO by allergic status was observed; asymptomatic, to early LAA, to asthma. One-way analysis of variance compared differences between groups (F ratio 13.93, P < 0.001). Symptomatic subjects also had raised nasal NO, vs asymptomatic subjects (mean difference 378 ppb, P < 0.05). A trend was again observed by allergic status (F ratio 5.28, P ¼ 0.01). Conclusion Raised NO levels in LAA increasing with symptom severity suggest NO may prove a useful additional tool in monitoring for LAA, and possibly the response to exposure reduction or allergy due to other respiratory sensitizers.