International Forum of Allergy & Rhinology最新文献

Background: The role of epithelial dysregulation is poorly understood in fungal sinusitis. We aimed to examine differential gene expression and quantify protease expression in sinonasal tissue from distinct patient cohorts, those with and without invasive fungal sinusitis (IFS). We hypothesized that abnormal epithelial integrity in the sinonasal mucosa of immunosuppressed IFS patients may allow for tissue invasion.

Methods: Bulk RNA sequencing was performed on tissue from eight patients from two cohorts: immunosuppressed patients with and without IFS. Evaluation of protein expression for select proteases and their inhibitors was performed on all sinonasal tissues using multiplex western blotting. To expand upon these findings, protein expression of proteases and their inhibitors was evaluated in sinonasal tissue from eight patients with non-invasive fungal sinusitis (fungal ball).

Results: Bulk RNA sequencing identified 33 genes that were differentially regulated in immunosuppressed IFS tissue compared to those without IFS. Multiplex western blot revealed several proteases, including matrix metalloproteinases (MMPs), with increased expression in the immunosuppressed IFS cohort compared to the cohorts without IFS. Tissue inhibitors of MMPs (TIMPs) were proportionally lower in IFS patient tissue compared to the control cohorts, resulting in several abnormal IFS-related MMP/TIMP ratios. In the non-invasive fungal sinusitis cohort, unique MMP/TIMP ratios were dysregulated.

Conclusions: Several proteases with increased expression in immunosuppressed IFS patients may be responsible for both an appropriate immune response to the pathogen as well as epithelial barrier breakdown and subsequent fungal invasion.

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.