Allergy - Miscellaneous

Question 1

Relationship between Nasal Obstruction and Sleep Disordered Breathing

Answer 1

1) Nasal obstruction worsens sleep d/o breathing
2) You can improve obstructive sleep apnea by improving the nasal airway via medical and/or surgical therapy
- Intranasal steroids improve sleep quality

Question 2

What Are Unusual Symptoms Of Allergies?

Answer 2

1) Post nasal drip
2) Sore throat
3) Sinus pressure
4) Hoarseness
5) Burning mouth

Question 3

What is Central Compartment Atopic Disease?

Answer 3

1) CCAD is a variant of Chronic Rhinosinusitis that is strongly associated with allergy. It is characterized by Polypoid mucosal Changes of the Central Sinonasal compartment/mucosa of ethmoid origin
- Polypoid changes involving the Middle and superior turbinates and posterior superior nasal septum
- The lateral sinus mucosa remains relatively normal
- Central compartment atopic disease may spread to the lateral sinuses as an obstructive phenomenon
2) CCAD is highly correlated with allergic rhinitis
3) CCAD involving the Middle turbinate is early stage disease; inclusion of the superior turbinate and posterior nasal septum is the next stage.
- Early disease has polypoid changes
- Polyps develop in later disease
- The medial ethmoid sinuses will then become involved with central clearing along the orbit, skull base, and maxillary ostium
- Severe disease will usually progress to complete sinus opacification via obstructive processes (lateral sinuses will have normal mucosa once they are opened and cleared of pus)
4) Successful treatment likely to require immunotherapy/allergy management as a key component of treatment
5) This may represent an immune response to local antigen contact in the areas most exposed to inhaled air.

Reference: DelGaudio et al, AJRA 2017

Question 4

Allergic Rhinitis and Inflammatory Mediators

Answer 4

In allergic rhinitis, you have an increase in multiple inflammatory mediators

Question 5

Allergy and Otologic Disease

Answer 5

1) Allergy is associated with Otitis Media with Effusion
- Secondary to Eustachian Tube Dysfunction
2) Inflammatory mediators are present/elevated in middle ear effusions
- Tryptase
- ECP
- MPO
3) Allergy is not an independent risk factor in Acute Otitis Media in children under 3 yrs old.
- Consider allergy in children > 3 yrs old with Otitis Media with Effusion. Atopy is common in child over 3 yrs old who have OME
- Atopy increases the likelihood of ETD
- A subgroup of children with OME have TH2 inflammation

Question 6

How do you treat central compartment Atopic disease/rhinitis?

Answer 6

Treat with immunotherapy

Question 7

Is there a causal relationship between chronic sinusitis with nasal polyposis and/or chronic sinusitis without nasal polyposis?

Answer 7

1) There is probably an association between allergic rhinitis and CRSwNP and CRSsNP, but there is no proven causal relationship between allergic rhinitis and chronic sinusitis.

Question 8

What percentage of patients with nasal polyposis has a positive skin prick test?

Answer 8

Approximately 60% of patients with nasal polyps have a positive skin prick test.

Reference: Pumhirun, et al

Question 9

What is the relationship between smoking and nasal polyp formation?

Answer 9

Smoking is a risk factor for nasal polyp formation

Reference: Gorgulu, et al

Question 10

What percentage of patients with chronic sinusitis have allergies?

Answer 10

50% of patients with chronic sinusitis have allergic rhinitis and 50% do not.

Question 11

What is the association between middle turbinate polypoid changes and allergic rhinitis?

Answer 11

The more severe the findings of diffuse and polypoid edema of the middle turbinate are, the more likely the patient is to have allergic rhinitis.

Question 12

Treatment of Central Compartment Atopic Disease

Answer 12

1) Most patient’s will require surgical therapy
2) Topical Budesonide Rinses
3) Immunotherapy

Question 13

What percentage of patient’s with Nasal Polyposis have allergic disease?

Answer 13

60% of patient’s with nasal polyps have a positive skin prick test while only 20% of a control group had a positive skin prick test.

Source: Pumhirun, et al

Question 14

What is the relationship between smoking and nasal polyposis?

Answer 14

Smoking is a significant risk factor in the formation of nasal polyps.

Question 15

What is the differential diagnosis of central compartment nasal polyps?

Answer 15

1) Central Compartment Atopic Disease

2) Aspirin Exacerbated Respiratory Disease

Question 16

Is there a relationship between allergy and laryngitis?

Answer 16

Yes - they are commonly associated

Question 17

What are the treatment options for allergies?

Answer 17

1) Avoidance - for symptom control
2) Medications - for symptom control
3) Immunotherapy - symptom control + a chance for cure by inducing tolerance

Question 18

Types of Immunity

Answer 18

1) Innate Immunity:
- Barriers: skin, mucous membranes, GI tract
- Cellular and molecular defenses: stomach acid, NK cells
2) Adaptive Immunity:
- Cellular defenses
- Humoral defenses

Question 19

What Cells/Systems Are Involved In Immunity?

Answer 19

1) Cells
- Eosinophils
- Basophils
- Mast cells
2) Systems: Major Histocompatibility Class I Molecules
- All nucleated cells express Major Histocompatibility Class I surface markers
- MHC helps regulate immune responses to endogenous epitopes, mainly viral and tumor
- MHC also helps self vs non self identification for cytotoxic T Cells and NKC (natural killer cells)