William J Doyle, Deborah A Gentile, David P Skoner
In contradistinction to the poetically inspired disjunction between the name and quality of a rose recited by Juliet in the famous quote from Shakespeare's play, disease labels used in the medical sciences need to have exact meaning to ensure that they communicate an accurate diagnosis and a valid treatment approach. Above, we presented a consistent nosology for rhinitis consequent to infection. There, we argued that the term "rhinitis" should be used to describe the condition of nasal mucosal pathology and that the rSSC be used to describe the appreciated expression of that pathology. In discussing viral and bacterial rhinitis, we conclude that former is consistent with a strict application of our nosology where the accompanying rSSC is usually referred to as cold or flu, but that the latter is not. Lacking direct evidence for bacterial infection of the nasal mucosa, bacterial rhinitis is better referred to as an acute bacterial infection of an adjacent compartment complicated by rhinitis (e.g., sinusitis complicated by rhinitis) or as "toxic rhinitis" complicated by bacterial infection. Interestingly, bacterial infection of the adjacent compartments is a frequent complication of viral rhinitis making "bacterial" rhinitis a complication of a complication of viral rhinitis. The antiviral and antibacterial host-defense mechanisms available to the nasal mucosa are multilayered and formidable. For this reason, nasal mucosal infection with extracellular bacterial pathogens is rarely established and infection with a broad range of upper respiratory viruses is self-limited with short duration morbidity and no mortality. However, in select subpopulations, those infections predispose to more serious complications associated with secondary bacterial, and perhaps viral, infection of the sinuses, middle ears, and lungs. The morbidity and mortality of these complications remains a concern, and strategies to decrease their frequency need to be formulated and tested in clinical trials. Because the viruses causing rhinitis are spread by interpersonal contact, the most appropriate and least expensive prophylactic measures are good hygiene and contact avoidance. Prophylactic efficacy for vaccination and passive immunoglobulin therapy was demonstrated for influenza and RSV infections, respectively. However, these approaches hold little promise for other viruses and are associated with some risks, making them less acceptable for populations "at low risk" for the more serious complications of viral rhinitis. Existing pharmacological treatments for viral rhinitis target the effector chemicals of the rSSC and therefore are largely palliative, whereas antiviral treatment has limited theoretical and realized efficacy, and no treatment has been shown to decrease the risk of complications. Indeed, given the small treatment window available (time between rSSC onset and typical resolution) and the poor understanding of the immune/inflammatory pathways of host defense,
{"title":"Viral and bacterial rhinitis.","authors":"William J Doyle, Deborah A Gentile, David P Skoner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In contradistinction to the poetically inspired disjunction between the name and quality of a rose recited by Juliet in the famous quote from Shakespeare's play, disease labels used in the medical sciences need to have exact meaning to ensure that they communicate an accurate diagnosis and a valid treatment approach. Above, we presented a consistent nosology for rhinitis consequent to infection. There, we argued that the term \"rhinitis\" should be used to describe the condition of nasal mucosal pathology and that the rSSC be used to describe the appreciated expression of that pathology. In discussing viral and bacterial rhinitis, we conclude that former is consistent with a strict application of our nosology where the accompanying rSSC is usually referred to as cold or flu, but that the latter is not. Lacking direct evidence for bacterial infection of the nasal mucosa, bacterial rhinitis is better referred to as an acute bacterial infection of an adjacent compartment complicated by rhinitis (e.g., sinusitis complicated by rhinitis) or as \"toxic rhinitis\" complicated by bacterial infection. Interestingly, bacterial infection of the adjacent compartments is a frequent complication of viral rhinitis making \"bacterial\" rhinitis a complication of a complication of viral rhinitis. The antiviral and antibacterial host-defense mechanisms available to the nasal mucosa are multilayered and formidable. For this reason, nasal mucosal infection with extracellular bacterial pathogens is rarely established and infection with a broad range of upper respiratory viruses is self-limited with short duration morbidity and no mortality. However, in select subpopulations, those infections predispose to more serious complications associated with secondary bacterial, and perhaps viral, infection of the sinuses, middle ears, and lungs. The morbidity and mortality of these complications remains a concern, and strategies to decrease their frequency need to be formulated and tested in clinical trials. Because the viruses causing rhinitis are spread by interpersonal contact, the most appropriate and least expensive prophylactic measures are good hygiene and contact avoidance. Prophylactic efficacy for vaccination and passive immunoglobulin therapy was demonstrated for influenza and RSV infections, respectively. However, these approaches hold little promise for other viruses and are associated with some risks, making them less acceptable for populations \"at low risk\" for the more serious complications of viral rhinitis. Existing pharmacological treatments for viral rhinitis target the effector chemicals of the rSSC and therefore are largely palliative, whereas antiviral treatment has limited theoretical and realized efficacy, and no treatment has been shown to decrease the risk of complications. Indeed, given the small treatment window available (time between rSSC onset and typical resolution) and the poor understanding of the immune/inflammatory pathways of host defense,","PeriodicalId":80264,"journal":{"name":"Clinical allergy and immunology","volume":"19 ","pages":"177-95"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26428402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Very little has been published regarding rhinitis in the elderly. Changes in the nose due to aging include structural, hormonal, mucosal, olfactory, and neural effects. The effects of polypharmacy may contribute to causing congestion and dryness. Physicians should look for treatable causes of rhinitis such as allergic rhinitis or rhinosinusitis, and rule out neurodegenerative disorders if applicable. Treatments that may provide symptomatic relief include humidification and antiallergy therapies. Surgery for structural and skin conditions of the external nose may also provide relief in some cases. As the U.S. population ages and remains in overall better health, we may learn more about the effects of aging on rhinitis.
{"title":"Rhinitis in the elderly.","authors":"A Asli Sahin-Yilmaz, Jacquelynne P Corey","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Very little has been published regarding rhinitis in the elderly. Changes in the nose due to aging include structural, hormonal, mucosal, olfactory, and neural effects. The effects of polypharmacy may contribute to causing congestion and dryness. Physicians should look for treatable causes of rhinitis such as allergic rhinitis or rhinosinusitis, and rule out neurodegenerative disorders if applicable. Treatments that may provide symptomatic relief include humidification and antiallergy therapies. Surgery for structural and skin conditions of the external nose may also provide relief in some cases. As the U.S. population ages and remains in overall better health, we may learn more about the effects of aging on rhinitis.</p>","PeriodicalId":80264,"journal":{"name":"Clinical allergy and immunology","volume":"19 ","pages":"209-19"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26428404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thomas Hummel, Mandy Scheibe, Thomas Zahnert, Basile N Landis
{"title":"Impact of nonallergic rhinitis on chemosensory function.","authors":"Thomas Hummel, Mandy Scheibe, Thomas Zahnert, Basile N Landis","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":80264,"journal":{"name":"Clinical allergy and immunology","volume":"19 ","pages":"389-400"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26428418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Allergic fungal sinusitis.","authors":"Mark S Schubert","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":80264,"journal":{"name":"Clinical allergy and immunology","volume":"20 ","pages":"263-71"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26747843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-01-01DOI: 10.3109/9781420014020-13
I. Brook
Incomplete resolution of acute rhinosinusitis leading to CRS is associated with a corresponding change in the microbiology of the disease. The shift in microbiology from acute to CRS favors infection with S. aureus, S. epidermidis, anaerobic bacteria (including beta-lactamase-producing strains), and gram-negative bacteria. With the exception of S. epidermidis, there is substantial evidence supporting the role of these organisms in the pathogenesis of CRS. It is worth noting that not all CRS patients are chronically infected. In fact, other inflammatory factors in the disease may predominate in the clinical presentation. This creates a clinical conundrum in which it is difficult to ascertain whether bacteria are involved. In general, a chronic bacterial infection is more likely if there is: underlying immune deficiency, one or more opacified sinuses on sinus CT in the absence of polyps, the presence of frank purulence draining from one or more sinus cavities, or the presence of gram-negative or antibiotic-resistant organisms (e.g., MRSA) on sinus culture. For patients seen for the first time, the approach to antibiotic treatment is usually empiric, following the guidelines outlined in this chapter and directing treatment at both aerobic and anaerobic bacteria. Whenever possible, the choice of antibiotics should be guided by properly obtained sinus cultures. In cases where empiric antibiotics have failed, the need for bacterial cultures is even more critical to assure proper treatment and to minimize antibiotic side effects.
{"title":"Bacterial infection and antibiotic treatment in chronic rhinosinusitis.","authors":"I. Brook","doi":"10.3109/9781420014020-13","DOIUrl":"https://doi.org/10.3109/9781420014020-13","url":null,"abstract":"Incomplete resolution of acute rhinosinusitis leading to CRS is associated with a corresponding change in the microbiology of the disease. The shift in microbiology from acute to CRS favors infection with S. aureus, S. epidermidis, anaerobic bacteria (including beta-lactamase-producing strains), and gram-negative bacteria. With the exception of S. epidermidis, there is substantial evidence supporting the role of these organisms in the pathogenesis of CRS. It is worth noting that not all CRS patients are chronically infected. In fact, other inflammatory factors in the disease may predominate in the clinical presentation. This creates a clinical conundrum in which it is difficult to ascertain whether bacteria are involved. In general, a chronic bacterial infection is more likely if there is: underlying immune deficiency, one or more opacified sinuses on sinus CT in the absence of polyps, the presence of frank purulence draining from one or more sinus cavities, or the presence of gram-negative or antibiotic-resistant organisms (e.g., MRSA) on sinus culture. For patients seen for the first time, the approach to antibiotic treatment is usually empiric, following the guidelines outlined in this chapter and directing treatment at both aerobic and anaerobic bacteria. Whenever possible, the choice of antibiotics should be guided by properly obtained sinus cultures. In cases where empiric antibiotics have failed, the need for bacterial cultures is even more critical to assure proper treatment and to minimize antibiotic side effects.","PeriodicalId":80264,"journal":{"name":"Clinical allergy and immunology","volume":"20 1","pages":"147-62"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69463555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-01-01DOI: 10.3109/9781420021172-23
E. Ellegård, N. Karlsson, L. Ellegård
By clinical experience, rhinitis has been suggested as caused by some endocrine disorders, but the evidence for this is vague, and the few descriptions almost anecdotal. Rhinitis of the menstrual cycle has been more described, although a solid picture is still lacking. Pregnancy rhinitis is therefore so far the only clearly defined "hormonal rhinitis." However, the cause of pregnancy rhinitis is not simply estrogen or progesterone, but seems multifactorial, and may possibly be associated with the PGH. Treatment consists mainly of information, physiological measures, and nasal saline washings.
{"title":"Rhinitis in the menstrual cycle, pregnancy, and some endocrine disorders.","authors":"E. Ellegård, N. Karlsson, L. Ellegård","doi":"10.3109/9781420021172-23","DOIUrl":"https://doi.org/10.3109/9781420021172-23","url":null,"abstract":"By clinical experience, rhinitis has been suggested as caused by some endocrine disorders, but the evidence for this is vague, and the few descriptions almost anecdotal. Rhinitis of the menstrual cycle has been more described, although a solid picture is still lacking. Pregnancy rhinitis is therefore so far the only clearly defined \"hormonal rhinitis.\" However, the cause of pregnancy rhinitis is not simply estrogen or progesterone, but seems multifactorial, and may possibly be associated with the PGH. Treatment consists mainly of information, physiological measures, and nasal saline washings.","PeriodicalId":80264,"journal":{"name":"Clinical allergy and immunology","volume":"19 1","pages":"305-21"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69464961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Questionnaire diagnosis of nonallergic rhinitis.","authors":"D. Brandt, J. Bernstein","doi":"10.3109/9781420021172-8","DOIUrl":"https://doi.org/10.3109/9781420021172-8","url":null,"abstract":"","PeriodicalId":80264,"journal":{"name":"Clinical allergy and immunology","volume":"19 1","pages":"55-67"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69465163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-01-01DOI: 10.3109/9781420021172-17
I. Alobid, J. Mullol, M. Cid
{"title":"Rhinitis of granulomatous and vasculitic diseases.","authors":"I. Alobid, J. Mullol, M. Cid","doi":"10.3109/9781420021172-17","DOIUrl":"https://doi.org/10.3109/9781420021172-17","url":null,"abstract":"","PeriodicalId":80264,"journal":{"name":"Clinical allergy and immunology","volume":"19 1","pages":"221-39"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69465410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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