BACKGROUND AND OBJECTIVES: Nasal irrigation, a conventional therapy for both surgical and nonsurgical patients with a history of chronic rhinosinusitis, aids in the clearance of secretions, debris, and intranasal crusts. This is important in the postoperative period to reduce the risk of adhesions and to promote ostiomeatal patency. The objective of this study was to compare the effects of a long-term nasal irrigation with hypertonic saline (3.0%) versus isotonic saline (0.9%) in the normal and postoperative group. MATERIALS AND METHODS: We studied the transit time of nasal mucociliary clearance with a saccharine test. In the normal control group I (n = 20), the mean transit times (MTTs) were measured before and after the irrigation with atomized saline of 0.9%, 2%, 3%, 4% and 5% concentrations. In the normal control group Il (n=19), MTTs were measured before and after the atomized 0.9%, 3% saline irrigation for two months. In the postoperative group (n=10), MTTs were measured after the irrigation with saline of 0.9% (right nasal cavity) & 3% (left nasal cavity) for one month. The symptom scores about nasal stuffiness, rhinorrhea and the amount of nasal lavage contents were recorded daily. RESULTS: In the normal control group I, MTT of 3% saline irrigation was significantly shortened than those of isotonic and other hypertonic saline irrigation. In the normal control group II, MTT of 3% saline irrigation was gradually and significantly shortened compared with those of isotonic saline for two months. In the postoperative group, 3% saline irrigation had a significantly shorter MTT for one month and had a significantly more nasal lavage contents during 1st week than isotonic saline irrigation. CONCLUSION: A 3% hypertonic saline would be useful as a long-term nasal washing solution in both surgical and non-surgical patients with a history of chronic rhinosinusitis.
Humans ; Mucociliary Clearance* ; Nasal Lavage ; Nasal Lavage Fluid ; Postoperative Period ; Saccharin

BACKGROUND AND OBJECTIVES: Chitin is a recognition element for tissue infiltration by innate cells implicated in allergy and asthma. Chitinases are characterized by the ability to cleave chitin. YKL-40, the chitinase-like protein, was increased during Th2-type inflammation in an exaggerated manner in tissues of patients with asthma. However, the relationship of YKL-40 level to allergic rhinitis has not been evaluated. Hence, we evaluated the relationship between the YKL-40 level in the blood and nasal lavage fluid and allergic inflammation in nasal cavity. We also evaluated the nature of association between several important factors (eosinophil count and total IgE) in the blood and nasal lavage fluid of allergic rhinitis patients. SUBJECTS AND METHOD: The concentrations of the YKL-40 levels in the blood and nasal lavage fluid were compared between allergic rhinitis patients and healthy controls. We evaluated the YKL-40 levels in the blood and nasal lavage fluid and also evaluated symptom severity, eosinophil count, and total IgE. RESULTS: The blood YKL-40 level was not significantly increased in allergic rhinitis (49 pg/mL) than in control (44 pg/mL)(p>0.05). The YKL-40 levels in the nasal lavage fluid was not significantly increased in allergic rhinitis (1568 pg/mL) than in control (1248 pg/mL)(p>0.05). The YKL-40 levels in blood and nasal lavage fluid were not associated with important factors such as symptom severity, eosinophil count, and total IgE in allergic rhinitis patients. CONCLUSION: There is no association between the YKL-40 level in the blood and nasal lavage fluid, allergic inflammation in nasal cavity.
Asthma ; Chitin ; Chitinase ; Eosinophils ; Humans ; Hypersensitivity ; Immunoglobulin E ; Inflammation ; Nasal Cavity ; Nasal Lavage ; Nasal Lavage Fluid ; Rhinitis ; Rhinitis, Allergic, Perennial

BACKGROUND AND OBJECTIVES: Although different methods of collecting nasal fluid exist and can influence the result of the study, there have not been any studies made yet to compare the different methods. The authors aimed to evaluate the usefulness of these methods by comparing the albumin concentration of nasal fluid after nasal provocation in patients with allergic rhinitis. SUBJECTS AND METHOD: In 22 patients with allergic rhinitis, we measured the change of nasal obstruction and rhinorrhea after nasal provocation using Visual Analogue Scale (VAS). In Group A (n=10), the nasal lavage and direct suction method were used and in Group B (n=12), nasal lavage and filter paper method were used. Nasal fluids were obtained before, 20 min after and 8 hours after provocation. The concentration of albumin was calculated using rate nephelometry. RESULTS: Patients' nasal symptoms were aggravated in early allergic reaction but subsided in late reaction. There was meaningful increase of albumin concentration with the use of direct suction and filter paper methods. In contrast, there was no significant increase of concentration with the use of lavage method. CONCLUSION: The filter paper method is superior in the quantitative analysis of mediators in nasal fluid after nasal provocation in allergic patients. The lavage method, however, is considered inappropriate because of its dilution effect.
Humans ; Hypersensitivity ; Nasal Lavage ; Nasal Lavage Fluid ; Nasal Obstruction ; Nasal Provocation Tests ; Nephelometry and Turbidimetry ; Rhinitis ; Rhinitis, Allergic, Perennial ; Suction ; Therapeutic Irrigation

Background: This study aimed to investigate the release and response of IL-18 to steroid treatment in the allergic rhinitis (AR) mouse model. MATERIALS AND METHODS: BALB/c mice were sensitized systematically using an intraperitoneal ovalbumin (OVA) injection and locally by OVA inhalation. The steroid treatment group had an intraperitoneal dexamethasone injection. Symptom scores, eosinophil counts in nasal septal mucosa, and IL-18 concentrations in nasal and lung lavage fluid were analyzed. RESULTS: The symptom scores and eosinophil counts of the negative control and steroid treatment groups were significantly lower than those of the positive control group (p<.01). Meanwhile IL-18 concentrations of nasal lavage fluid of the three groups were not significantly different (56.68+/-9.57, 63.39+/-8.93, and 64.47+/-6.83 pg/mL, repectively). IL-18 concentration of lung lavage fluid was significantly different between the positive control and steroid treatment groups (430.75+/-154.54 and 69.94+/-14.26pg/mL respectively, p=.028). CONCLUSION: In this study, IL-18 concentration increased not in the nasal lavage fluid but in the lung lavage fluid in AR mouse model. The increased IL-18 concentration decreased after the steroid therapy. This result suggests that the role of IL-18 in the pathogenesis of AR may be different from that of asthma.
Animals ; Asthma ; Bronchoalveolar Lavage Fluid ; Dexamethasone ; Eosinophils ; Inhalation ; Interleukin-18* ; Mice* ; Mucous Membrane* ; Nasal Lavage Fluid ; Ovalbumin ; Ovum ; Rhinitis*

BACKGROUND AND OBJECTIVES: Although the mechanism of ozone-induced airway inflammation and hyperresponsiveness is largely unknown, NO and peroxynitrite has been suggested to be associated with it. Ebselen, a seleno-organic compound, is known to inhibit the production of superoxide, iNOS-related NO, and their combined product, peroxynitrite. The purpose of this study is to investigate whether ebselen suppress ozone-induced nasal inflammation and whether ebselen inhibit the production of NO and peroxynitrite in nasal mucosa. SUBJECTS AND METHOD: Thirty-six BALB/c mice were divided into three groups: control group, ozone exposure group, and ozone+ebselen treated group. In the ozone exposure group, mice were exposed to 1 ppm ozone for 8 hours a day for 3 consecutive days. In the ebselen treated group, the ebselen (32.5 mg/kg) solution was injected intraperitoneally 1 hour before and 3 hours after the ozone exposure. At 18 hours of the last ozone exposure, Evans blue was infused via tail vein in 6 animals of each group. Mice were sacrificed five minutes later and nasal mucosa was obtained to measure the amount of extravasated Evans blue dye. From the remaining 6 animals in each group, nasal lavage fluid (NLF) was obtained to measure the concentration of albumin and the number of neutrophils. After lavage fluid was obtained, nasal mucosa was taken for immunohistochemical staining against iNOS and nitrotyrosine usng the ABC method. RESULTS: Extravasation of Evans blue was significantly increased in the ozone exposure group, but it was significantly decreased in the ebselen treated group. Albumin concentration in NLF showed a tendency to increase in the ozone exposure group and a tendency to decrease in the ebselen treated group when compared with the ozone exposure group. The number of neutrophils was significantly increased in the ozone exposure group and was decreased more in the ebselen treated group than in the ozone exposure group. Immunoreactivity to iNOS and nitrotyrosine was strongly expressed in nasal mucosa of the ozone exposure group. However, it was nearly abolished by the treatment with ebselen. CONCLUSIONS: These results may suggest that ebselen can be applied as a useful therapeutic agent for airway diseases by modulating the oxidant-related inflammatory process.
Animals ; Evans Blue ; Inflammation* ; Mice* ; Nasal Lavage Fluid ; Nasal Mucosa ; Neutrophils ; Nitric Oxide ; Ozone ; Peroxynitrous Acid ; Superoxides ; Therapeutic Irrigation ; Veins

This study used nasal lavage fluid for metabolomics to explore its feasibility, and applied it to the clinical metabolomics study of Xiaoqinglong Decoction in the treatment of allergic rhinitis(AR), aiming to investigate the molecular mechanism of Xiaoqing-long Decoction in the treatment of AR through differential changes in local nasal metabolism. AR patients were selected as the research subjects, and nasal lavage fluid was collected as the sample. Metabolomics analysis using liquid chromatography-mass spectrometry was performed on normal group, AR group, and Xiaoqinglong Decoction group. The differences in metabolic profiles among the groups were compared using principal component analysis and partial least squares discriminant analysis, and differential metabolites were identified and subjected to corresponding metabolic pathway analysis. The results showed that Xiaoqinglong Decoction significantly improved the symptoms of AR patients. The metabolomics analysis revealed 20 differential metabolites between AR group and Xiaoqinglong Decoction group. The core metabolite with a trending return in comparison to normal group was trimethyladipic acid. The metabolites were involved in multiple pathways, including β-alanine metabolism, glutathione metabolism, and phenylalanine, tyrosine, and tryptophan biosynthesis. The feasibility of applying nasal lavage fluid in nasal metabolomics was preliminarily demonstrated. Differential metabolites and enriched pathways in the treatment of AR patients with Xiaoqinglong Decoction were identified, indicating that it may improve rhinitis symptoms through the regulation of various metabolites, including antioxidant effects and correction of Th1/Th2 imbalance.
Humans ; Nasal Lavage Fluid ; Rhinitis, Allergic/drug therapy* ; Metabolomics/methods* ; Metabolome

OBJECTIVES: Alpha1-antitrypsin (AAT) is the main inhibitor of human neutrophil elastase, and plays a role in counteracting the tissue damage caused by elastase in local inflammatory conditions. The study evaluated the involvement of AAT in nasal allergic inflammation. METHODS: Forty subjects with mono-sensitization to Dermatophagoides pteronyssinus (Dpt) were enrolled. Twenty allergic rhinitis patients frequently complained of nasal symptoms such as rhinorrhea, stuffiness, sneezing, and showed positive responses to the nasal provocation test (NPT) with Dpt (Group I). The other 20 asymptomatic patients showed sensitization to Dpt but negative NPT (Group II). The levels of AAT, eosinophil cationic protein (ECP), and Dpt-specific IgA antibodies were measured in the nasal lavage fluids (NLFs), collected at baseline, 10 minutes, 30 minutes, 3 hours, and 6 hours after the NPT. Nasal mucosa AAT expression was evaluated with immunohistochemical staining from Group I and Group II. RESULTS: At baseline, only the Dpt-specific IgA level was significantly increased in the NLFs of Group I compared with Group II, while ECP and AAT levels were not significantly different between two groups. After Dpt provocation, AAT, ECP, and Dpt-specific IgA levels were significantly increased in the NLFs of Group I during the early and late responses. The protein expression level of AAT was mostly found in the infiltrating inflammatory cells of the nasal mucosa, which was significantly increased in Group I compared to Group II. CONCLUSION: The increment of AAT showed a close relationship with the activation of eosinophils induced by allergen-specific IgA in the NLFs of patients with allergic rhinitis after allergen stimulation. These findings implicate AAT in allergen-induced nasal inflammation.
Antibodies ; Dermatophagoides pteronyssinus ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Immunoglobulin A ; Inflammation ; Leukocyte Elastase ; Nasal Lavage Fluid ; Nasal Mucosa ; Nasal Provocation Tests ; Pancreatic Elastase ; Rhinitis ; Rhinitis, Allergic, Perennial ; Sneezing

OBJECTIVES: Alpha1-antitrypsin (AAT) is the main inhibitor of human neutrophil elastase, and plays a role in counteracting the tissue damage caused by elastase in local inflammatory conditions. The study evaluated the involvement of AAT in nasal allergic inflammation. METHODS: Forty subjects with mono-sensitization to Dermatophagoides pteronyssinus (Dpt) were enrolled. Twenty allergic rhinitis patients frequently complained of nasal symptoms such as rhinorrhea, stuffiness, sneezing, and showed positive responses to the nasal provocation test (NPT) with Dpt (Group I). The other 20 asymptomatic patients showed sensitization to Dpt but negative NPT (Group II). The levels of AAT, eosinophil cationic protein (ECP), and Dpt-specific IgA antibodies were measured in the nasal lavage fluids (NLFs), collected at baseline, 10 minutes, 30 minutes, 3 hours, and 6 hours after the NPT. Nasal mucosa AAT expression was evaluated with immunohistochemical staining from Group I and Group II. RESULTS: At baseline, only the Dpt-specific IgA level was significantly increased in the NLFs of Group I compared with Group II, while ECP and AAT levels were not significantly different between two groups. After Dpt provocation, AAT, ECP, and Dpt-specific IgA levels were significantly increased in the NLFs of Group I during the early and late responses. The protein expression level of AAT was mostly found in the infiltrating inflammatory cells of the nasal mucosa, which was significantly increased in Group I compared to Group II. CONCLUSION: The increment of AAT showed a close relationship with the activation of eosinophils induced by allergen-specific IgA in the NLFs of patients with allergic rhinitis after allergen stimulation. These findings implicate AAT in allergen-induced nasal inflammation.
Antibodies ; Dermatophagoides pteronyssinus ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Immunoglobulin A ; Inflammation ; Leukocyte Elastase ; Nasal Lavage Fluid ; Nasal Mucosa ; Nasal Provocation Tests ; Pancreatic Elastase ; Rhinitis ; Rhinitis, Allergic, Perennial ; Sneezing

BACKGROUND AND OBJECTIVES: Allergic rhinitis and asthma display many similarities in their epithelial and inflammatory responses to allergens. However, one notable difference is that disruption and desquamation of the epithelium is a characteristic feature of asthma, whereas, in allergic rhinitis, the epithelium is intact. Airway remodeling is a well-recognized feature among patients with chronic asthma but not in allergic rhinitis. The purpose of this study is to investigate the airway remodeling in mice with experimentally induced airway allergy. SUBJECTS AND METHOD: Male BALB/c mice were systemically sensitized with ovalbumin mixed with aluminum hydroxide gel solution and were challenged with aerosols of ovalbumin. Then, the mice were chronically exposed to aerosols of ovalbumin for 5 weeks to 10 weeks. After the last exposure, bronchoalveolar lavage fluid (BALF) and nasal lavage fluid (NLF) were collected. Next, the number of inflammatory cells and the concentrations of IL-5, IL-13, TGF-beta and IFN-gamma in BALF and NLF were measured. Finally, nasal cavity and lung specimen were obtained to evaluate the subepithelial fibrosis by trichrome stain and the expression of MMP-9 and TIMP-1 by immunohistochemical stain. RESULTS: The concentrations of IL-5, IL-13, TGF-beta within the BALF & NLF were found to have significantly increased in the 10-week exposed group compared with the control group. The expression of MMP-9, TIMP-1 and subepithelial fibrosis in the lung tissue were also found to have significantly increased in the 10-week exposed group comparative to that of the control group. But the expression of MMP-9, TIMP-1 and subepithelial fibrosis in the nasal mucosa were not prominent in the 10-week exposed group compared with the control group. CONCLUSION: The results suggest that airway remodeling may be induced by repeated allergen exposure in allergic rhinitis but the structural changes of the nasal mucosa by remodeling process are less prominent compared with the lung tissue.
Aerosols ; Airway Remodeling* ; Allergens ; Aluminum Hydroxide ; Animals ; Asthma ; Bronchoalveolar Lavage Fluid ; Epithelium ; Fibrosis ; Humans ; Hypersensitivity* ; Interleukin-13 ; Interleukin-5 ; Lung ; Male ; Mice* ; Nasal Cavity ; Nasal Lavage Fluid ; Nasal Mucosa ; Ovalbumin ; Rhinitis ; Tissue Inhibitor of Metalloproteinase-1 ; Transforming Growth Factor beta

PURPOSE: Extensive data support the influence of the upper airway on lower airway inflammation and pathophysiology in allergic disease. However, few studies have focused on allergic inflammation in the nose after an isolated lower airway allergen challenge, a situation that can exist clinically when human subjects breathe primarily through the mouth, as occurs when nasally congested. This study used a mouse model to investigate whether upper airway inflammation and hyperresponsiveness were induced by an isolated lower airway allergen challenge. METHODS: BALB/c mice were sensitized by systemic intraperitoneal injection of ovalbumin/saline and challenged with intratracheal ovalbumin/saline. Inflammation in the nose and lungs was assessed by cytology and histology of nasal tissues and bronchoalveolar lavage fluid (BALF), while nasal airway resistance and response were measured over 3 days post-challenge. RESULTS: Intratracheal application of an allergen in anaesthetized mice resulted in exclusive deposition in the lower airway. Compared to control animals, ovalbumin-sensitized mice after challenge showed bronchial hyperreactivity and increased IL-5 in the serum BALF, as well as eosinophil infiltration in the lungs. However, nasal histology of the ovalbumin-sensitized mice showed no increase in eosinophil infiltration. The nasal lavage fluid revealed no increase in eosinophils or IL-5, and the nasal airway resistance did not increase after challenge either. CONCLUSIONS: In a mouse allergy model, exclusive allergen challenge of the lower airway can elicit a pulmonary and systemic allergic response, but does not induce upper airway inflammatory or physiological responses.
Airway Resistance ; Animals ; Asthma* ; Bronchial Hyperreactivity ; Bronchoalveolar Lavage Fluid ; Eosinophils ; Estrogens, Conjugated (USP) ; Humans ; Hypersensitivity ; Inflammation* ; Injections, Intraperitoneal ; Interleukin-5 ; Lung ; Mice ; Mouth ; Nasal Lavage Fluid ; Nose* ; Rhinitis