Effect of Postoperative Specific Immunotherapy Combined with Nasal Irrigation on Chronic Rhinosinusitis with Allergic Rhinitis
Abstract
Patients with chronic rhinosinusitis (CRS) and allergic rhinitis (AR) (CRSwAR) have a more severe condition with a higher rate of recurrence after endoscopic sinus surgery (ESS). This study aimed to explore the effect of specific subcutaneous immunotherapy (SCIT) and nasal irrigation on CRSwAR after ESS.
Sixty-four patients who were diagnosed as CRSwAR and received ESS were enrolled and divided into groups A, B, and C to receive different postoperative treatment strategies (conventional medication, medication with nasal irrigation, and medication with nasal irrigation and SCIT), and their prognosis was evaluated by scoring, electron microscopy, and inflammatory factors.
One year after ESS, the recurrence rate of group C was significantly reduced; and the scoring from baseline was significantly different among the three groups, which of group C were the best. The epithelium arrangement, cilia morphology, and inflammation of nasal mucosa in each group were better than those in the preoperative state; and those in group C were the best. After one year, the expression levels of eosinophil cationic protein (ECP), interleukin (IL)-8, and IL-17 in group B were lower than those of group A; and the expression levels of ECP, IL-8, IL-25, IL-33, IL-17 in group C were lower than those in group A.
SCIT combined with nasal irrigation can improve the patients' symptoms and quality of life, promote the epithelialization of the mucosa in the surgical cavity, regulate the local immune response of the nasal cavity; thus improve the prognosis of patients with ESS after 1 year.
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3. Hamsa N Subramanian, Kenneth B Schechtman, Daniel L Hamilos. A retrospective analysis of treatment outcomes and time to relapse after intensive medical treatment for chronic sinusitis[J]. Am J Rhinol. 2002;16(6):303-12.
4. Pete S Batra 1 , Liyue Tong, Martin J Citardi. Analysis of comorbidities and objective parameters in refractory chronic rhinosinusitis. Laryngoscope, 2013,123Suppl7:S1-S11.
5. Michael Katotomichelakis, Efthimios Simopoulos, Nan Zhang, Gregory Tripsianis, GerasimosDanielides, MiltosLivaditis. Olfactory dysfunction and asthma as risk factors for poor quality of life in upper airway diseases. Am J Rhinnl Allergy. 2013;27(4):293-8.
6. Thibaut Van Zele, Gabriele Holtappels, Philippe Gevaert, Claus Bachert. Differences in initial immunoprofiles between recurrent and nonrecurrent chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy, 2014, 28(3):192-8.
7. Yang Shen 1 , Guo-Hua Hu, Yu-Cheng Yang, Xia Ke, Xin-Ye Tang, Su-Ling Hong. Allergen induced Th17 response in the peripheral blood mononuclear cells (PBMCs) of patients with nasal polyposis. International Immunopharmacology. 2012;12(1):235-4.
8. Yang Shen, Guo-Hua Hu, Yu-Cheng Yang, Xia Ke, Xin-Ye Tang, Su-Ling Hong. Allergen induced Th17 response in the peripheral blood mononuclear cells (PBMCs) of patients with nasal polyposis. IntImmunopharmacol. 2012;12(1):235-4.
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10. Nan Zhang, Thibaut Van Zele, Claudina Perez-Novo, Nicholas Van Bruaene, Gabriele Holtappels, Natalie DeRuyck， et al. Different types of T-effector cells orchestrate mucosal inflammation in chronic sinus disease. J Allergy Clin Immunol. 2008;122(5):961-8.
11. J Bousquet, N Khaltaev, A A Cruz, J Denburg, WJ Fokkens, A Togias, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;(63 Suppl):8-160.
12. P-L Bastier, A Lechot, L Bordenave, M Durand, L de Gabor，et al. Nasal irrigation: From empiricism toevidence-based medicine. A review.Eur Ann Otorhinolaryngol Dis. 2015;132(5):281-5.
13. Wytske J Fokkens, Valerie J Lund, Joachim Mullol, Claus Bachert, IsamAlobid, Fuad Baroody, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl. 2012
14. David Rabago, Aleksandra Zgierska, Marlon Mundt, Bruce Barrett, James Bobula, Rob Maberry. Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: a randomized controlled trial. J Fam Pract. 2002;51(12):1049-55.
15. Chia-Ling Li, Hsiao-Chuan Lin, Chien-Yu Lin, Teh-Fu Hsu. Effectiveness of Hypertonic Saline Nasal Irrigation for Alleviating Allergic Rhinitis in Children: A Systematic Review and Meta-Analysis. J Clin Med. 2019;8(1):64-8.
16. Satdhabudha A, Poachanukoon O. Efficacy of buffered hypertonic saline nasal irrigation in children with symptomatic allergic rhinitis: a randomized double-blind study. Int J PediatrOtorhinolaryngol. 2012;76(4):583-8.
17. Wang Lei，XIE Jing-hua，JI Xiao-bin. The Effect of Different Dose of Nasal Irrigation Liquid on the Postoperative Patients with ChronicRhinosinusitis with Nasal Polyps[J]. Medical Innovation of China. 2014,11(24):4-7.
18. Liu Y, Wang F. Effects of different pH irrigating fluids on the epithelialization of the surgical cavity after nasal endoscopic surgery[J]. Chin J OtorhinolaryngolInteg Med. 2017,25(01):65-67.
19. Kucuksezer UC, Ozdemir C, Akdis M, Akdis CA. Chronic rhinosinusitis: pathogenesis, therapy options, and more.Expert OpinPharmacother. 2018;19(16):1805-15.
20. Bachert C, Gevaert P, Holtappels G, Cuvelier C, van Cauwenberge P. Nasal polyposis: from cytokines to growth. Am J Rhinol. 2000;14(5):279–90.
21. Rong Xiang, Qing-Ping Zhang, Wei Zhang, Yong-Gang Kong, Lu Tan, Shi-Ming Chen, et al. Different effects of allergic rhinitis on nasal mucosa remodeling in chronic rhinosinusitis with and without nasal polyps. Eur Arch Otorhinolaryngol. 2019;276(1):115–30.
22. Guo-Qing Gong, Fang-Fang Ren, Yan-Jun Wang, Lang Wan, Shan Chen, Jie Yuan, et al. Expression of IL-17 and syndecan-1 in nasal polyps and their correlation with nasal polyps. J Huazhong Univ Sci Technolog Med Sci. 2017;37(3):412–8.
23. Jiao J, Duan S, Meng N, Li Y, Fan E, Zhang L. Role of IFN-γ, IL-13, and IL-17 on mucociliary differentiation of nasal epithelial cells in chronic rhinosinusitis with nasal polyps. Clin Exp Allergy. 2016;46(3):449–60.
24. Xiaohong Chen, Lihong Chang, Xia Li, JiancongHuang , Luoying Yang, Xiaoping Lai, et al. Tc17/IL-17A Up-Regulated the Expression of MMP-9 via NF-κB Pathway in Nasal Epithelial Cells of Patients With Chronic Rhinosinusitis. Front Immunol. 2018;9:2121.
25. Xu M, Dong C. IL-25 in allergic inflammation. Immunol Rev. 2017;278(1):185–91.
26. Cayrol C, Girard JP. Interleukin-33 (IL-33): A nuclear cytokine from the IL-1 family. Immunol Rev. 2018;281(1):154–68.
27. Rosati MG, Peters AT. Relationships among allergic rhinitis, asthma, and chronic rhinosinusitis. Am J Rhinol Allergy. 2016;30(1):44-7.
28. Tomassen P, Vandeplas G, Van Zele T, Cardell LO, Arebro J, Olze H, et al. Inflammatory endotypes of chronic rhinosinusitis based on cluster analysis of biomarkers. J Allergy Clin Immunol. 2016;137(5):1449–1456.
29. Bachert C, Gevaert P, Hellings P. Biotherapeutics in Chronic Rhinosinusitis with and without Nasal Polyps. J Allergy Clin Immunol Pract. 2017;5(6):1512–6.
30. Shamji MH, Durham SR. Mechanisms of allergen immunotherapy for inhaled allergens and predictive biomarkers. J Allergy Clin Immunol. 2017;140(6):1485-98.
31. Succar EF, Turner JH, Chandra RK. Nasal saline irrigation: a clinical update. Int Forum Allergy Rhinol. 2019;9(S1):S4-S8.
2. Claire Hopkins, Robert Slack, Valerie Lund, Peter Brown, Lynn Copley, John Browne. Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis[J]. Laryngoscope. 2009;119(12):2459-65.
3. Hamsa N Subramanian, Kenneth B Schechtman, Daniel L Hamilos. A retrospective analysis of treatment outcomes and time to relapse after intensive medical treatment for chronic sinusitis[J]. Am J Rhinol. 2002;16(6):303-12.
4. Pete S Batra 1 , Liyue Tong, Martin J Citardi. Analysis of comorbidities and objective parameters in refractory chronic rhinosinusitis. Laryngoscope, 2013,123Suppl7:S1-S11.
5. Michael Katotomichelakis, Efthimios Simopoulos, Nan Zhang, Gregory Tripsianis, GerasimosDanielides, MiltosLivaditis. Olfactory dysfunction and asthma as risk factors for poor quality of life in upper airway diseases. Am J Rhinnl Allergy. 2013;27(4):293-8.
6. Thibaut Van Zele, Gabriele Holtappels, Philippe Gevaert, Claus Bachert. Differences in initial immunoprofiles between recurrent and nonrecurrent chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy, 2014, 28(3):192-8.
7. Yang Shen 1 , Guo-Hua Hu, Yu-Cheng Yang, Xia Ke, Xin-Ye Tang, Su-Ling Hong. Allergen induced Th17 response in the peripheral blood mononuclear cells (PBMCs) of patients with nasal polyposis. International Immunopharmacology. 2012;12(1):235-4.
8. Yang Shen, Guo-Hua Hu, Yu-Cheng Yang, Xia Ke, Xin-Ye Tang, Su-Ling Hong. Allergen induced Th17 response in the peripheral blood mononuclear cells (PBMCs) of patients with nasal polyposis. IntImmunopharmacol. 2012;12(1):235-4.
9. Ping-Ping Cao, Hua-Bin Li, Bao-Feng Wang, Shui-Bin Wang, Xue-Jun You, Yong-Hua Cui, et al. Distinct immunopathologic characteristics of various types of chronic rhinosinusitis in adult Chinese. J Allergy Clin Immunol. 2009;124(3):478-84.
10. Nan Zhang, Thibaut Van Zele, Claudina Perez-Novo, Nicholas Van Bruaene, Gabriele Holtappels, Natalie DeRuyck， et al. Different types of T-effector cells orchestrate mucosal inflammation in chronic sinus disease. J Allergy Clin Immunol. 2008;122(5):961-8.
11. J Bousquet, N Khaltaev, A A Cruz, J Denburg, WJ Fokkens, A Togias, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;(63 Suppl):8-160.
12. P-L Bastier, A Lechot, L Bordenave, M Durand, L de Gabor，et al. Nasal irrigation: From empiricism toevidence-based medicine. A review.Eur Ann Otorhinolaryngol Dis. 2015;132(5):281-5.
13. Wytske J Fokkens, Valerie J Lund, Joachim Mullol, Claus Bachert, IsamAlobid, Fuad Baroody, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl. 2012
14. David Rabago, Aleksandra Zgierska, Marlon Mundt, Bruce Barrett, James Bobula, Rob Maberry. Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: a randomized controlled trial. J Fam Pract. 2002;51(12):1049-55.
15. Chia-Ling Li, Hsiao-Chuan Lin, Chien-Yu Lin, Teh-Fu Hsu. Effectiveness of Hypertonic Saline Nasal Irrigation for Alleviating Allergic Rhinitis in Children: A Systematic Review and Meta-Analysis. J Clin Med. 2019;8(1):64-8.
16. Satdhabudha A, Poachanukoon O. Efficacy of buffered hypertonic saline nasal irrigation in children with symptomatic allergic rhinitis: a randomized double-blind study. Int J PediatrOtorhinolaryngol. 2012;76(4):583-8.
17. Wang Lei，XIE Jing-hua，JI Xiao-bin. The Effect of Different Dose of Nasal Irrigation Liquid on the Postoperative Patients with ChronicRhinosinusitis with Nasal Polyps[J]. Medical Innovation of China. 2014,11(24):4-7.
18. Liu Y, Wang F. Effects of different pH irrigating fluids on the epithelialization of the surgical cavity after nasal endoscopic surgery[J]. Chin J OtorhinolaryngolInteg Med. 2017,25(01):65-67.
19. Kucuksezer UC, Ozdemir C, Akdis M, Akdis CA. Chronic rhinosinusitis: pathogenesis, therapy options, and more.Expert OpinPharmacother. 2018;19(16):1805-15.
20. Bachert C, Gevaert P, Holtappels G, Cuvelier C, van Cauwenberge P. Nasal polyposis: from cytokines to growth. Am J Rhinol. 2000;14(5):279–90.
21. Rong Xiang, Qing-Ping Zhang, Wei Zhang, Yong-Gang Kong, Lu Tan, Shi-Ming Chen, et al. Different effects of allergic rhinitis on nasal mucosa remodeling in chronic rhinosinusitis with and without nasal polyps. Eur Arch Otorhinolaryngol. 2019;276(1):115–30.
22. Guo-Qing Gong, Fang-Fang Ren, Yan-Jun Wang, Lang Wan, Shan Chen, Jie Yuan, et al. Expression of IL-17 and syndecan-1 in nasal polyps and their correlation with nasal polyps. J Huazhong Univ Sci Technolog Med Sci. 2017;37(3):412–8.
23. Jiao J, Duan S, Meng N, Li Y, Fan E, Zhang L. Role of IFN-γ, IL-13, and IL-17 on mucociliary differentiation of nasal epithelial cells in chronic rhinosinusitis with nasal polyps. Clin Exp Allergy. 2016;46(3):449–60.
24. Xiaohong Chen, Lihong Chang, Xia Li, JiancongHuang , Luoying Yang, Xiaoping Lai, et al. Tc17/IL-17A Up-Regulated the Expression of MMP-9 via NF-κB Pathway in Nasal Epithelial Cells of Patients With Chronic Rhinosinusitis. Front Immunol. 2018;9:2121.
25. Xu M, Dong C. IL-25 in allergic inflammation. Immunol Rev. 2017;278(1):185–91.
26. Cayrol C, Girard JP. Interleukin-33 (IL-33): A nuclear cytokine from the IL-1 family. Immunol Rev. 2018;281(1):154–68.
27. Rosati MG, Peters AT. Relationships among allergic rhinitis, asthma, and chronic rhinosinusitis. Am J Rhinol Allergy. 2016;30(1):44-7.
28. Tomassen P, Vandeplas G, Van Zele T, Cardell LO, Arebro J, Olze H, et al. Inflammatory endotypes of chronic rhinosinusitis based on cluster analysis of biomarkers. J Allergy Clin Immunol. 2016;137(5):1449–1456.
29. Bachert C, Gevaert P, Hellings P. Biotherapeutics in Chronic Rhinosinusitis with and without Nasal Polyps. J Allergy Clin Immunol Pract. 2017;5(6):1512–6.
30. Shamji MH, Durham SR. Mechanisms of allergen immunotherapy for inhaled allergens and predictive biomarkers. J Allergy Clin Immunol. 2017;140(6):1485-98.
31. Succar EF, Turner JH, Chandra RK. Nasal saline irrigation: a clinical update. Int Forum Allergy Rhinol. 2019;9(S1):S4-S8.
| Files | ||
| Issue | Vol 20 No 4 (2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijaai.v20i4.6953 | |
| Keywords | ||
| Allergic rhinitis Immunotherapy Nasal irrigation | ||
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How to Cite
1.
Li J, Kang H, Hong S, Shen Y. Effect of Postoperative Specific Immunotherapy Combined with Nasal Irrigation on Chronic Rhinosinusitis with Allergic Rhinitis. Iran J Allergy Asthma Immunol. 2021;20(4):432-440.
