International Forum of Allergy & Rhinology最新文献

Background: Endoscopic posterior nasal nerve (PNN) neurectomy and temperature-controlled radiofrequency ablation are validated interventions for medication-refractory allergic rhinitis (AR), but direct comparisons of their long-term efficacy, safety, and mechanisms remain lacking.

Methods: In this prospective, multicenter, randomized, patient-blinded study, 174 adults with moderate-to-severe persistent AR were allocated to PNN neurectomy (n = 89) or ablation (n = 85). The primary endpoint was the percentage of participants achieving the minimal clinically important difference (MCID) for the 24-h reflective total nasal symptom score (rTNSS) at 24 months.

Results: The rTNSS MCID responder rate at 24 months was 86.5% (95% confidence interval [CI], 80.0-95.0%) in the neurectomy group and 84.9% (95% CI, 78.0-94.0%) in the ablation group, with no significant between-group difference (p = 0.453). Both groups demonstrated substantial and parallel improvements in quality of life. Neurectomy provided greater and more durable control of rhinorrhea (1-24 months, all p < 0.05), nasal congestion (24 months, p < 0.001), and nasal itching (24 months, p = 0.046), alongside a greater reduction in unilateral nasal resistance (right side, p = 0.014). Both groups showed convergent systemic neuroimmune reprogramming at 1 year, with suppression of substance P, interleukin (IL)-31, IL-33, IL-4, IL-13, and IL-6, and increased transforming growth factor-β (TGF-β)and immunoglobulin G4 (IgG4). No serious adverse events occurred; mild transitory events were reported only with neurectomy (3.4%).

Conclusion: Both techniques are effective and safe for refractory AR over 2 years. Although overall outcomes are comparable, neurectomy offers superior and sustained control of rhinorrhea, nasal congestion, and nasal itching. Treatment can be individualized based on symptom profile.

Background: To determine the safety and efficacy of laser ablation of the posterior nasal nerve (PNN) for the treatment of chronic rhinitis.

Methods: This study was a single-center, prospective, single-blinded, randomized sham-controlled trial. Patients with a 24-h reflective Total Nasal Symptom Score (rTNSS) ≧ 5, rhinorrhea ≧ 2, and congestion ≧ 1, were randomized 2:1 to active PNN treatment with a CO₂ laser device or a sham procedure. Outcome measures included the rTNSS, Nasal Obstruction Symptom Evaluation (NOSE), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). The primary endpoint was the change in scores at 3 months.

Results: Patients had a mean baseline rTNSS of 8.5 (95% CI, 7.9-9.1) and 8.2 (95% CI, 7.4-8.9) (p = 0.589) in the active treatment (n = 43) and sham control (n = 22) arms, respectively. At 3 months, the active treatment arm had a significantly greater decrease in rTNSS -4.7 (95% CI, -5.5 to -3.9) versus -2.6 (95% CI, -3.4 to -1.8) (p = 0.002). While the responder rate (RR, defined as ≧30% improvement rTNSS) was not significantly higher in the active treatment arm (81.4% vs. 63.6%, p = 0.119), post-hoc analysis of RR (≧ 50% improvement) showed a significantly higher rate of 65.1% versus 31.8% (p = 0.011). There were greater improvements in the PSQI and ESS scores for the active arm over the sham arm at follow-ups. (p = 0.041 and 0.005, respectively).

Conclusions: The CO₂ laser posterior nasal neurolysis of the PNN area is associated with minimal adverse events and is superior to a sham procedure in reducing the symptom burden of chronic rhinitis.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent, often Type 2-mediated inflammatory disease that markedly impairs quality of life. While dupilumab provides rapid improvement, there is limited evidence on long-term outcomes beyond 2 years, and the clinical impact of dosing-interval extension remains unclear. We therefore set out to evaluate long-term real-world outcomes of dupilumab therapy in CRSwNP and assess the effectiveness and safety of dosing-interval extension after achieving disease control.

Methods: This retrospective single-center cohort included 224 adults with CRSwNP (37% with nonsteroidal anti-inflammatory drug-exacerbated respiratory disease) treated with dupilumab for up to 4.5 years with outcomes modeled to 5 years. Longitudinal changes in polyp size, symptom burden, olfaction, asthma control, and Type 2 biomarkers were analyzed using mixed-effects models. Outcomes were then compared between patients who maintained standard 2-week dosing and those who voluntarily extended dosing intervals after achieving stable control.

Results: Dupilumab led to significant improvements in polyp burden, olfactory function, and quality of life peaking within 6 months, with sustained benefit through 5 years according to longitudinal modeling. Forty percent of patients extended dosing intervals without loss of efficacy and reported fewer treatment-related adverse events. Overall, 16% experienced side effects, most commonly musculoskeletal complaints, followed by skin reactions and injection site reactions.

Conclusion: Long-term dupilumab therapy provided durable disease control and excellent safety. Personalized dosing-interval extension maintained efficacy and reduced treatment burden, supporting its potential role in optimizing long-term management of CRSwNP, especially in patients with troublesome side effects.

Air pollution has long been recognized as a threat to human health. There is growing evidence that exposure to air pollution increases the risk of upper airway inflammatory disease including allergic and non-allergic rhinitis, and chronic rhinosinusitis. Recent improvement in air pollution measurement, including wearable pollution monitors, may improve our understanding of patient exposures. In this piece, we summarize salient literature and interventions.

Background: Local allergic rhinitis (LAR) is a chronic rhinitis (CR) phenotype with localized IgE production but no systemic atopy. Diagnosis relies on the nasal allergen challenge (NAC), but its correlation with the underlying immunological endotype is unclear, necessitating a more reliable biomarker. Therefore, this study was conducted to evaluate a local specific immunoglobulin E (sIgE) threshold for diagnosing house dust mite (HDM)-sensitized LAR and compare its immunological relevance to the conventional NAC-based method.

Methods: This prospective study enrolled 181 CR patients without systemic atopy and 146 healthy controls. All CR patients underwent NAC. Local sIgE levels of Dermatophagoides pteronyssinus and Dermatophagoides farinae were measured in nasal secretions. A diagnostic threshold was established using the 95th percentile from the healthy cohort. The NAC and sIgE-based stratifications were then compared by analyzing patients' nasal cytokine profiles.

Results: Classification based on NAC positivity did not reveal significant differences in local sIgE or a consistent type 2 inflammatory signature. In contrast, stratification using the established local sIgE threshold (≥ 0.14 kUA/L) identified a local sIgE-high group with significantly elevated levels of type 2 cytokines (IL-4, IL-5, CCL5, and CCL11) compared to the sIgE-low group (all p < 0.05). Furthermore, local sIgE levels positively correlated with these type 2 cytokines in the sIgE-high group.

Conclusion: A local sIgE threshold reliably identifies an immunologically distinct LAR endotype, aligning diagnosis with its type 2 pathophysiology. This biomarker-driven approach offers a precise tool to refine diagnostic algorithms and improve patient selection for targeted therapies.

Background: Olfactory dysfunction is common in aging and an early symptom of neurodegenerative diseases, but how structural (olfactory bulb [OB] volume) and functional (olfactory network [OFN] functional connectivity [FC]) brain features interact to shape odor identification ability remains unclear. Therefore, we assessed the interrelations among OB volume, OFN FC, and odor identification ability in a large population-based cohort.

Methods: Using cross-sectional data from 5605 participants of the Rhineland Study (age range: 30-95 years), we extracted OB volume and OFN FC from 3T MRI scans. Odor identification was examined with the 12-item "Sniffin' Sticks" test. Using linear regression, we examined the relations between OB volume, OFN FC, and odor identification.

Results: A smaller OB was associated with worse odor identification (standardized β = 0.09, 95% confidence interval: 0.06-0.12). This association was stronger in men and strongest in older individuals of both sexes. Only in participants with a large OB, lower OFN FC was significantly associated with worse odor identification (standardized β between 0.03 and 0.12), especially among older participants (62-95 years) and in memory-related regions (hippocampus, amygdala, and orbitofrontal cortex).

Conclusion: Our findings demonstrate the importance of OB volume in detecting olfactory dysfunction. Moreover, they reveal that the OB contributes to odor identification both directly and by modulating central network function, offering new insights into olfactory dysfunction as a potential biomarker for neurodegeneration.

Key points: Most state Medicaid programs granted omalizumab (91.4%) and dupilumab (59.5%) preferred drug status. Omalizumab was the most commonly prescribed therapy among Medicaid patients between 2015 and2024.