International Forum of Allergy & Rhinology最新文献

Key points: Environmental and occupational inhalational exposures are linked to chronic rhinosinusitis The Sinonasal Occupational Airborne Pollutant Exposure (SOAPE) survey assesses lifetime exposure to inhalational irritants CRS patients who underwent sinus surgery reported higher inhalational exposures.

Background: Identifying predictive and monitoring biomarkers for allergen immunotherapy response is crucial for enhancing clinical efficacy. This study aims to investigate the systemic and local levels of immunoglobulins and identify potential biomarkers in house dust mite (HDM) allergic rhinitis (AR) patients who are undergoing subcutaneous immunotherapy (SCIT).

Methods: This study enrolled 114 AR patients who completed 1-year SCIT follow-up. High responders and low responders were classified based on >30% improvement in the average total combined score (ATCS). Immunoglobulin levels of HDM and its major components were measured in serum and nasal secretions before and after treatment. Predictive index (Pi) and therapeutic index (Ti) analyses were performed using linear regression to assess the impact of baseline immunoglobulin concentrations and their pre- to post-treatment changes on symptom alleviation. Receiver operating characteristic (ROC) curve analysis with area under the curve (AUC) quantification was performed to evaluate predictive value for clinical responses.

Results: Positive SCIT response correlated with lower baseline age and higher symptom scores, allergen-specific IgE (sIgE) levels, and sIgE/total IgE (tIgE) ratio. Pi analysis revealed that elevated pre-treatment nasal sIgE levels and higher sIgE/tIgE ratios for Der p, Der f, Der p 1, and Der p 2 distinguished high from low responders. Ti analysis showed that post-treatment decreases in these nasal sIgE levels correlated with improved clinical outcomes. Logistic regression showed baseline sIgE/tIgE ratios for Der p and Der f both in serum and nasal secretions, and Der p 1 and Der p 2 in serum positively correlated with clinical improvement. The sIgE/tIgE ratios of Der p (0.833 vs. 0.758) and Der f (0.813 vs. 0.738) in nasal secretions exhibited higher AUC values compared to serum.

Conclusions: Immunologic indicators in nasal secretions are potential biomarkers for the effective prediction and monitoring of early SCIT responses.

High-risk dysplasia and multifocal attachment independently predict inverted papilloma recurrence. Novel nomogram generates individualized 3-, 6-, and 9-year recurrence risk estimates. Risk-stratified surveillance may optimize postoperative monitoring intensity and intervals.

Background: The purpose of this randomized controlled trial (RCT) was to demonstrate that posterior nasal nerve ablation treatment with the NEUROMARK System is superior to a sham control procedure in patients with chronic rhinitis.

Methods: In this prospective, multicenter, single-blinded, superiority RCT, 132 participants were randomized 2:1 to the active treatment arm (88) and sham control arm (44). The primary endpoint was the comparison of the reflective Total Nasal Symptom Score (rTNSS) responder rate between study arms at 90-day follow-up. Secondary efficacy outcomes included postnasal drip, chronic cough, Nasal Obstruction Symptom Evaluation (NOSE), mini-Rhinoconjunctivitis Quality of Life Questionnaire (mini-RQLQ), and Patient Health Questionnaire-9 (PHQ-9) (a depression assessment).

Results: The responder rate was significantly higher for the active treatment arm: 73.3% (95% confidence interval [CI], 64.0%-82.7%) compared to the sham control arm: 35.0% (95% CI, 20.2%-49.8%; p < 0.001). The primary endpoint was met, demonstrating the active treatment arm is superior to the sham control arm. The active treatment arm had significantly greater decreases (improvements) in the rTNSS (-4.0 vs. -1.2, p < 0.0001), postnasal drip (-1.1 vs. -0.3, p < 0.001), cough (-0.9 vs. -0.1, p < 0.001), NOSE score (-32.2 vs. -8.0, p < 0.0001), mini-RQLQ (-1.7 vs. -0.5, p < 0.0001), and PHQ-9 (-3.0 vs. -0.7, p = 0.028), compared to the sham control arm. The NOSE responder rate and mini-RQLQ responder rate were significantly higher for the active treatment arm than the sham control arm (p = 0.001 and p < 0.0001, respectively).

Conclusion: Treatment for chronic rhinitis with the NEUROMARK System is superior to sham control.

Most physicians hold antithrombotic medication prior to surgery, regardless of drug class Physicians rely on the cardiologist or their own experience for perioperative decision making There was no consensus on antithrombotic perioperative medication timing across drug classes.

Background: Staphylococcus aureus biofilms play a crucial role in chronic rhinosinusitis (CRS), leading to the persistence of symptoms. Severe CRS patients are frequently infected with S. aureus strains that exhibit higher biofilm properties (e.g., biomass, exoprotein production) compared to S. aureus from controls. S. aureus biofilms resist antibiotic treatment; however, the relationship between bacterial biofilm properties, antibiotic susceptibility, and CRS severity has not yet been defined and is the subject of this study.

Methods: S. aureus clinical isolates and reference strains, and matched clinical datasets were collected from CRS patients and controls (n  =  35). Antimicrobial susceptibility of the isolates to clindamycin, mupirocin, clarithromycin, doxycycline, and amoxicillin-clavulanic acid was determined by minimum inhibitory concentration (MIC) and minimum biofilm eradication concentration (MBEC).

Results: S. aureus MBEC values (n  =  35) were significantly higher (up to 11 times) than the MIC for all five antibiotics (p < 0.001). Among the various antibiotics tested, mupirocin had the strongest antibiofilm activity and amoxicillin-clavulanic acid the weakest: at antibiotic concentrations that are deemed to indicate susceptibility or intermediate resistance when testing in planktonic form, 80% biofilm eradication was reached for all isolates using mupirocin and only 5/35 isolates using amoxicillin-clavulanic acid. The biofilm metabolic activity, biomass, colony-forming units, and exoprotein production were positively correlated with the MBEC values for amoxicillin-clavulanic acid and clarithromycin, but not for the other antibiotics. Lund-Mackay and Lund-Kennedy disease severity scores showed positive correlations with the MBEC values of clarithromycin.

Conclusion: These findings show that whilst severe CRS patients are frequently infected with S. aureus strains that exhibit higher biofilm-mediated virulence, these biofilms are also more difficult to control with standard of care antibiotics. Better personalized therapies are required to manage biofilm-mediated infections in severe CRS patients.