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Jonathan A Bernstein - One of the best experts on this subject based on the ideXlab platform.

  • intranasal capsaicin in management of nonallergic vasomotor Rhinitis
    Progress in drug research, 2014
    Co-Authors: Umesh Singh, Jonathan A Bernstein
    Abstract:

    Capsaicin is a selective transient receptor potential vanilloid 1 (TRPV1) ion channel agonist and has been demonstrated to reduce nerve conduction of nociceptive C fibers in the trigeminal nerve without affecting conduction in Aδ fibers. This chapter reviews the classification of Chronic Rhinitis subtypes, the prevalence and epidemiology of nonallergic Rhinitis (NAR), postulated pathophysiology and mechanisms of NAR including the role of transient receptor potential (TRP) ion channels and discusses the potential therapeutic benefits of capsaicin in the treatment of Chronic Rhinitis subtypes, specifically NAR. Evidence supports that hypersensitivity of TRP ion channels on sensory afferent neurons innervating nasal mucosa is responsible for inducing NAR symptoms. These symptoms, characterized as excessive nasal glandular secretion, nasal congestion, and headache, are mediated through neuropeptide release during axonal and parasympathetic reflexes which are initiated by a spectrum of nonspecific irritants that activate TRP channels. Rational approaches to treat the pathophysiology of NAR would be to develop therapies with selective TRPV1 agonist activity like capsaicin that target desensitization of TRP ion channels on sensory afferent nerves.

  • Characteristics of Nonallergic Vasomotor Rhinitis
    World Allergy Organization Journal, 2009
    Co-Authors: Jonathan A Bernstein
    Abstract:

    Nonallergic Rhinitis (NAR) conditions are currently considered diagnoses by exclusion. A diagnosis of NAR requires negative specific IgE responses by skin or serologic testing and more recently testing to exclude localized production of specific IgE in the nose. Symptoms are classically aggravated by irritant triggers such as tobacco smoke, perfumes/fragrances, and temperature or barometric pressure changes. A previously developed questionnaire survey designed to help physicians recognize differences between allergic Rhinitis and nonallergic Rhinitis subtypes found that patients with symptom onset later in life (> 35 years), no family history of allergies, no seasonality or cat-induced symptoms, and symptoms induced by perfumes and fragrances had > 95% likelihood of having a physician diagnosis of NAR. Of note, clinical symptoms were not generally useful for differentiating Chronic Rhinitis subtypes which has also been confirmed in a more recent study investigating the relationship between headaches and Chronic Rhinitis subtypes (Table 1 ). In subsequent studies it was found that a significant percentage of NAR patients did not experience irritant-induced symptoms, suggesting that these triggers are not a clinical characteristic that can be uniformly used for all NAR patients. However, a newly developed Irritant Index Scale can be used to reliably differentiate pure allergic Rhinitis from nonallergic Rhinitis with trigger phenotypes. The use of standardized and validated questionnaires allows objective characterization of Chronic Rhinitis subtypes that appears to improve the accuracy of clinically diagnosing these patients.

  • questionnaire evaluation and risk factor identification for nonallergic vasomotor Rhinitis
    Annals of Allergy Asthma & Immunology, 2006
    Co-Authors: Dominique Brandt, Jonathan A Bernstein
    Abstract:

    Background Chronic Rhinitis, a prevalent primary care disorder associated with significant comorbidities, is often incorrectly diagnosed. As a result, inappropriate treatment leads to higher health care costs and poor clinical outcomes. Objective To verify whether responses to specific questions may help in the diagnosis of nonallergic vasomotor Rhinitis (NAVMR). Methods A questionnaire listing allergic and nonallergic triggers was blindly distributed to 100 random new patients with Chronic Rhinitis in an allergist's office. Questionnaire and physician diagnoses were compared. Allergic triggers included cat, dog, feathers, other furry animals, and symptoms during the spring, summer, and fall seasons. Nonallergic triggers included temperature changes, diesel and car exhaust, tobacco smoke, perfumes and fragrances, incense, cleaning products, newsprint, hairspray, and alcoholic beverages, spicy foods, or eating. Results The construct validity and internal consistency indicated that the questionnaire was a good tool for diagnosing NAVMR. Multivariate analysis revealed that the absence of outdoor symptoms in the spring (odds ratio [OR], 7.76; 95% confidence interval [CI], 1.18-51.22; P = .03), no parental history of allergy (OR, 5.16; 95% CI, 1.05-25.20; P = .04), no symptoms around cats (OR, 3.82; 95% CI, 0.59-24.83; P = .16), the presence of symptoms around perfumes and fragrances (OR, 4.875; 95% CI, 1.05-22.60; P = .04), and age at symptom onset (OR, 1.08; 95% CI, 1.02-1.14; P = .008) were predictive of NAVMR. Conclusions Specific questionnaire responses may help primary care physicians accurately diagnose NAVMR. Questions asked of patients by physicians to diagnose allergic Rhinitis do not correlate well with physician diagnosis.

Michael R Knowles - One of the best experts on this subject based on the ideXlab platform.

  • primary ciliary dyskinesia diagnostic and phenotypic features
    American Journal of Respiratory and Critical Care Medicine, 2004
    Co-Authors: Peadar G Noone, Margaret W Leigh, Aruna Sannuti, Susan L Minnix, Johnny L Carson, Milan J Hazucha, Maimoona B Zariwala, Michael R Knowles
    Abstract:

    Primary ciliary dyskinesia (PCD) is a genetic disease characterized by abnormalities in ciliary structure/function. We hypothesized that the major clinical and biologic phenotypic markers of the disease could be evaluated by studying a cohort of subjects suspected of having PCD. Of 110 subjects evaluated, PCD was diagnosed in 78 subjects using a combination of compatible clinical features coupled with tests of ciliary ultrastructure and function. Chronic Rhinitis/sinusitis (n = 78; 100%), recurrent otitis media (n = 74; 95%), neonatal respiratory symptoms (n = 57; 73%), and situs inversus (n = 43; 55%) are strong phenotypic markers of the disease. Mucoid Pseudomonas aeruginosa (n = 12; 15%) and nontuberculous mycobacteria (n = 8; 10%) were present in older (> 30 years) patients with PCD. All subjects had defects in ciliary structure, 66% in the outer dynein arm. Nasal nitric oxide production was very low in PCD (nl/minute; 19 ± 17 vs. 376 ± 124 in normal control subjects). Rigorous clinical and ciliary ph...

  • primary ciliary dyskinesia diagnostic and phenotypic features
    American Journal of Respiratory and Critical Care Medicine, 2004
    Co-Authors: Peadar G Noone, Margaret W Leigh, Aruna Sannuti, Susan L Minnix, Johnny L Carson, Milan J Hazucha, Maimoona B Zariwala, Michael R Knowles
    Abstract:

    Primary ciliary dyskinesia (PCD) is a genetic disease characterized by abnormalities in ciliary structure/function. We hypothesized that the major clinical and biologic phenotypic markers of the disease could be evaluated by studying a cohort of subjects suspected of having PCD. Of 110 subjects evaluated, PCD was diagnosed in 78 subjects using a combination of compatible clinical features coupled with tests of ciliary ultrastructure and function. Chronic Rhinitis/sinusitis (n = 78; 100%), recurrent otitis media (n = 74; 95%), neonatal respiratory symptoms (n = 57; 73%), and situs inversus (n = 43; 55%) are strong phenotypic markers of the disease. Mucoid Pseudomonas aeruginosa (n = 12; 15%) and nontuberculous mycobacteria (n = 8; 10%) were present in older (> 30 years) patients with PCD. All subjects had defects in ciliary structure, 66% in the outer dynein arm. Nasal nitric oxide production was very low in PCD (nl/minute; 19 +/- 17 vs. 376 +/- 124 in normal control subjects). Rigorous clinical and ciliary phenotyping and measures of nasal nitric oxide are useful for the diagnosis of PCD. An increased awareness of the clinical presentation and diagnostic criteria for PCD will help lead to better diagnosis and care for this orphan disease.

Kornkiat Snidvongs - One of the best experts on this subject based on the ideXlab platform.

  • effects of decongestant addition to intranasal corticosteroid for Chronic Rhinitis a systematic review and meta analysis
    International Forum of Allergy & Rhinology, 2018
    Co-Authors: Likhit Khattiyawittayakun, Kachorn Seresirikachorn, Wirach Chitsuthipakorn, Dichapong Kanjanawasee, Kornkiat Snidvongs
    Abstract:

    Background Intranasal corticosteroid (INCS) is the most efficacious medicine for treating Chronic Rhinitis. A decongestant and INCS combination (INCS-D) is considered for nasal congestion that is not improved by INCS. This study aimed to investigate the effects of INCS-D on Chronic Rhinitis. Methods Literature searches were performed using MEDLINE and EMBASE. Randomized controlled trials studying the effects of INCS-D vs INCS alone for treating Chronic Rhinitis were included. Data were pooled for meta-analysis. Outcomes were nasal symptoms, disease-specific quality of life, objective tests for nasal patency, and adverse events. Results Six studies (1071 patients) met the inclusion criteria. There were no differences between INCS-D and INCS on total nasal symptom scores (standardized mean difference [SMD] -0.85; 95% confidence interval [CI], -2.09 to 0.40; p = 0.18), nasal congestion scores (SMD -0.13; 95% CI, -0.46 to 0.20; p = 0.43), and the Rhinoconjunctivitis Quality of Life Questionnaire score (SMD -0.12; 95% CI, -0.66 to 0.42; p = 0.66). After 1 week, there were no differences on objective tests for nasal patency (acoustic rhinometry: SMD 0.04; 95% CI, -0.68 to 0.76, p = 0.91; and peak nasal inspiratory flow: SMD 0.08; 95% CI, -0.16 to 0.32; p = 0.52). Adverse events were not different between INCS-D and INCS (risk ratio 1.09; 95% CI, 0.73 to 1.62). Conclusion Meta-analyses did not show benefits of topical decongestants addition to INCS. Adverse events of INCS-D were comparable with INCS.

Peadar G Noone - One of the best experts on this subject based on the ideXlab platform.

  • primary ciliary dyskinesia diagnostic and phenotypic features
    American Journal of Respiratory and Critical Care Medicine, 2004
    Co-Authors: Peadar G Noone, Margaret W Leigh, Aruna Sannuti, Susan L Minnix, Johnny L Carson, Milan J Hazucha, Maimoona B Zariwala, Michael R Knowles
    Abstract:

    Primary ciliary dyskinesia (PCD) is a genetic disease characterized by abnormalities in ciliary structure/function. We hypothesized that the major clinical and biologic phenotypic markers of the disease could be evaluated by studying a cohort of subjects suspected of having PCD. Of 110 subjects evaluated, PCD was diagnosed in 78 subjects using a combination of compatible clinical features coupled with tests of ciliary ultrastructure and function. Chronic Rhinitis/sinusitis (n = 78; 100%), recurrent otitis media (n = 74; 95%), neonatal respiratory symptoms (n = 57; 73%), and situs inversus (n = 43; 55%) are strong phenotypic markers of the disease. Mucoid Pseudomonas aeruginosa (n = 12; 15%) and nontuberculous mycobacteria (n = 8; 10%) were present in older (> 30 years) patients with PCD. All subjects had defects in ciliary structure, 66% in the outer dynein arm. Nasal nitric oxide production was very low in PCD (nl/minute; 19 ± 17 vs. 376 ± 124 in normal control subjects). Rigorous clinical and ciliary ph...

  • primary ciliary dyskinesia diagnostic and phenotypic features
    American Journal of Respiratory and Critical Care Medicine, 2004
    Co-Authors: Peadar G Noone, Margaret W Leigh, Aruna Sannuti, Susan L Minnix, Johnny L Carson, Milan J Hazucha, Maimoona B Zariwala, Michael R Knowles
    Abstract:

    Primary ciliary dyskinesia (PCD) is a genetic disease characterized by abnormalities in ciliary structure/function. We hypothesized that the major clinical and biologic phenotypic markers of the disease could be evaluated by studying a cohort of subjects suspected of having PCD. Of 110 subjects evaluated, PCD was diagnosed in 78 subjects using a combination of compatible clinical features coupled with tests of ciliary ultrastructure and function. Chronic Rhinitis/sinusitis (n = 78; 100%), recurrent otitis media (n = 74; 95%), neonatal respiratory symptoms (n = 57; 73%), and situs inversus (n = 43; 55%) are strong phenotypic markers of the disease. Mucoid Pseudomonas aeruginosa (n = 12; 15%) and nontuberculous mycobacteria (n = 8; 10%) were present in older (> 30 years) patients with PCD. All subjects had defects in ciliary structure, 66% in the outer dynein arm. Nasal nitric oxide production was very low in PCD (nl/minute; 19 +/- 17 vs. 376 +/- 124 in normal control subjects). Rigorous clinical and ciliary phenotyping and measures of nasal nitric oxide are useful for the diagnosis of PCD. An increased awareness of the clinical presentation and diagnostic criteria for PCD will help lead to better diagnosis and care for this orphan disease.

Heungman Lee - One of the best experts on this subject based on the ideXlab platform.

  • medical data science in rhinology background and implications for clinicians
    American Journal of Otolaryngology, 2020
    Co-Authors: Young Joon Jun, Joonho Jung, Heungman Lee
    Abstract:

    Abstract Background An important challenge of big data is using complex information networks to provide useful clinical information. Recently, machine learning, and particularly deep learning, has enabled rapid advances in clinical practice. The application of artificial intelligence (AI) and machine learning (ML) in rhinology is an increasingly relevant topic. Purpose We review the literature and provide a detailed overview of the recent advances in AI and ML as applied to rhinology. Also, we discuss both the significant benefits of this work as well as the challenges in the implementation and acceptance of these methods for clinical purposes. Methods We aimed to identify and explain published studies on the use of AI and ML in rhinology based on PubMed, Scopus, and Google searches. The search string “nasal OR respiratory AND artificial intelligence OR machine learning” was used. Most of the studies covered areas of paranasal sinuses radiology, including allergic Rhinitis, Chronic Rhinitis, computed tomography scans, and nasal cytology. Results Cluster analysis and convolutional neural networks (CNNs) were mainly used in studies related to rhinology. AI is increasingly affecting healthcare research, and ML technology has been used in studies of Chronic Rhinitis and allergic Rhinitis, providing some exciting new research modalities. Conclusion AI is especially useful when there is no conclusive evidence to aid decision making. ML can help doctors make clinical decisions, but it does not entirely replace doctors. However, when critically evaluating studies using this technique, rhinologists must take into account the limitations of its applications and use.

  • correlation between skin prick testing individual specific ige tests and a multiallergen ige assay for allergy detection in patients with Chronic Rhinitis
    American Journal of Rhinology & Allergy, 2014
    Co-Authors: Jae Hoon Cho, Seok Chan Hong, Jeffrey D. Suh, Jin Kook Kim, Il Ho Park, Heungman Lee
    Abstract:

    BackgroundAllergy test results can differ based on the method used. The most common tests include skin-prick testing (SPT) and in vitro tests to detect allergen-specific IgE. This study was designe...

  • epidermal growth factor receptor signaling mediates regranulation of rat nasal goblet cells
    The Journal of Allergy and Clinical Immunology, 2001
    Co-Authors: Heungman Lee, Iris F Ueki, Lars Malm, Karim Dabbagh, Trang Daopick, Suil Kim, Jae Jeong Shim, Jay A Nadel
    Abstract:

    Abstract Background: Mucus hypersecretion is a common response to inflammation in the lower airways and is a hallmark of Chronic Rhinitis. Objective: The purpose of this study was to elucidate the mechanisms of regranulation (mucus production) of goblet cells in nasal epithelium. Methods: Because neutrophils induce an epidermal growth factor (EGFR) cascade, we induced degranulation of goblet cells in rat nasal respiratory epithelium by means of intranasal inhalation of N-formyl-methionyl-leucyl-phenylalanine (fMLP), and we examined regranulation of the goblet cells and the role of EGFR inhibitors and neutrophils in the regranulation process. Results: In the control state Alcian blue/periodic acid–Schiff and mucin MUC5AC staining was present. Degranulation was induced in the nasal septal epithelium 4 hours after intranasal inhalation of fMLP (10 –7 mol/L); 48 hours later, goblet-cell regranulation was complete. In the control state EGFR protein staining was absent in the epithelium, but after fMLP-induced degranulation, EGFR protein was expressed. After pretreatment with BIBX1522, a selective EGFR tyrosine kinase inhibitor, fMLP-induced degranulation was unaffected, but goblet-cell regranulation was prevented completely. Conclusion: These data suggest a role for the EGFR cascade in neutrophil-dependent production of goblet-cell mucins. Proving this theory will require the use of selective EGFR inhibitors in clinical studies of nasal hypersecretory states. (J Allergy Clin Immunol 2001;107:1046-50.)