Advances in Asthma, Allergy, and Immunology Series 2007 Advances in upper airway diseases and allergen immunotherapy HaroldS. Nelson, MD Denver, Colo The purpose of this review is … … highlight important articles on upper airway diseases and immunotherapy that appeared during 2006. Studies from Europe continue to examine the usefulness of the Allergic Rhinitis and its Impact on Asthma classification of allergic rhinitis as intermittent or persistent and its levels of severity as mild or moderate/severe. A number of physical …

weather, 6 of whom had allergic rhinitis, received nasal challenges with cold, dry air and with warm, moist air.11 A6-fold increase in sloughed nasal epithelial cells followed cold, dry air but not warm, moist air challenge. No similar increase in sloughing of nasal epithelial cells was observed after cold, dry air challenge in subjects not reporting symptoms on exposure to cold or windy weather. It was concluded that the nasal mucosa of indi- vidualssensitive to cold dry air cannot compensate for the water loss that occurs under extreme conditions, lead- ingtoepithelial damage. Forty-one children in Paris with asthma and 44healthy children were monitored for 48 hours for their personal exposure to particles 2.5 mmor less in diameter (PM 2.5 ).12 Attheendofthe measurement period, subjects underwent nasal lavage. In the children with asthma but not in the healthy children, personal PM 2.5 levels were correlated with nasal percentage eosin- ophilsandwith markers of nasal exudation. The study demonstrated the association between exposure to fine particulate air pollution and nasal inflammation in children with allergic asthma in an urban area. Mechanisms of rhinitis The role of the nervous system in rhinitis was reviewed.13 Sensory nerves transmit signals from the mucosa, generating sensations such as pruritus, motor reflexes such as sneezing, and parasympathetic and sympathetic reflexes that affect the glandular and vascular nasal apparatuses. Reflexes affecting nasal symptoms also arise from other body regions, and reflexes arising in the nose can affect the lower airway. Nasal hyperres- ponsivenesscan arise as a result of inflammatory products such as neurotropins, among which is the nerve growth factor. Nasal tissue samples from patients undergoing par- tialturbinectomy for nasal obstruction were examined for nerve growth factor (NGF) and nerve growth factor receptors.14 NGFwas localized to activated eosinophils and submucosal glands and less to epithelial lining. NGF receptors were localized not only on nerves but also on nasal epithelium, submucosal glands, and some interstitial cells. It was concluded that the distribution of NGF and its receptors and its established release during allergic reactions suggest that this factor participates in the pathophysiology of allergic rhinitis. The role of dendritic cells in allergic rhinitis was examined in both human beings and mice.15 In nasal mucosal biopsies from symptomatic patients with perennialrhinitis, the number of dendritic cells in the epithelium and laminapropria was increased compared with healthy controls.

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