Biomedical subjects

Fuad M Baroody

Publications and source records attributed to Fuad M Baroody.

9 recordsLinked to original sources

PubMed2003

Fluticasone nasal spray and the combination of loratadine and montelukast in seasonal allergic rhinitis.

OBJECTIVE: To compare the effectiveness of an intranasal steroid treatment with that of the combination of a histamine1 receptor antagonist and a leukotriene D receptor antagonist in the treatment of seasonal allergic rhinitis. DESIGN: A 2-week, parallel, randomized, double-blind, double-dummy study with rolling enrollment. SETTING: Tertiary care medical center. Subjects A total of 63 adults with a 2-year history of ragweed sensitivity in the Chicago, Ill, area and a positive skin-prick reaction to ragweed pollen. Intervention Subjects were randomized to receive either 100 micro g of fluticasone propionate aqueous nasal spray in each nostril or 10 mg of loratadine and 10 mg of montelukast sodium by mouth once daily in the evening for 2 weeks. At visits 1 and 2, subjects completed a quality-of-life questionnaire and underwent nasal lavage to determine total eosinophil count and eosinophil cationic protein (ECP) measurements. Daily symptom diaries were kept for 2 weeks. MAIN OUTCOME MEASURES: Questionnaire answers, daily nasal symptom scores, eosinophil counts, and ECP levels. RESULTS: Median total nasal symptom scores were lower in the fluticasone group (4.5 vs 6), but the difference was not statistically significant. The questionnaire answers showed dramatic improvement in overall and individual domains for both groups (P<.01 vs visit 1) with significantly greater reduction in nasal symptoms in the fluticasone group (P<.05). Eosinophil counts and ECP levels were significantly reduced in the fluticasone group. CONCLUSION: Both treatments provided clinically meaningful responses, but the overall results favored fluticasone propionate.

Acetates↗

PubMed2003

Relationships between atopy and bacterial infections.

Atopy in its most common forms (asthma, allergic rhinitis, and atopic dermatitis) has a significant impact on society in terms of health care costs and quality of life. Aside from having significant morbidity from these diseases, patients with atopy have also been noted to have a high incidence of comorbidities, including bacterial infections such as otitis media and sinusitis. In this paper, current evidence is reviewed that supports the close associations among allergic rhinitis and the two commonly diagnosed bacterial diseases, otitis media and sinusitis.

Asthma↗

PubMed2003

Allergic rhinitis: broader disease effects and implications for management.

Allergic rhinitis is a burdensome disease for a significant part of the population in both adults and children. Poorly controlled allergic rhinitis can trigger exacerbations of asthma, sinusitis, and otitis media, diseases with which it shares common pathophysiologic elements. Consequently, early diagnosis and treatment should be a priority for patients and physicians, not only to control the symptoms of allergic rhinitis but also to improve the management of associated diseases. Several pharmacologic therapies can be considered in an armamentarium that includes antihistamines (intranasal and systemic), intranasal cromolyn, intranasal anticholinergic agents, intranasal steroids, systemic steroids, immunotherapy, and, most recently, leukotriene receptor antagonists. Often, combinations of these treatments are used to maximize control of refractory symptoms.

Adult↗

PubMed2003

A comparison of nasal clearance after treatment of perennial allergic rhinitis with budesonide and mometasone.

OBJECTIVE: Evidence in vitro suggests that benzalkonium chloride, a preservative in many intranasal preparations, interferes with ciliary function and thus could potentially interfere with mucociliary transport, the mechanism for clearing secretions from the nasal cavity. STUDY DESIGN: We performed a parallel randomized study with 10 subjects in each arm comparing Rhinocort AQUA (an intranasal steroid [budesonide] spray without benzalkonium chloride) and Nasonex (an intranasal steroid [mometasone furoate] spray with benzalkonium chloride). Before and after 2 weeks of treatment, subjects completed a Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and underwent a measurement of nasal clearance of a radioactive colloidal spray into the nose. RESULTS: The groups were matched at entry for nasal clearance, even though there was variability among subjects. The amount of change after 2 weeks of treatment (Delta before versus after treatment) showed a significant difference in nasal clearance favoring budesonide. After 2 weeks of treatment, both budesonide and mometasone demonstrated overall improvement in quality of life as assessed by the RQLQ. Both treatments were well tolerated. CONCLUSION: Our study extends the observation in vitro that demonstrates the adverse effect of benzalkonium chloride on cilia to a measurement in vivo of clearance. The effects after 2 weeks might not reflect changes after longer periods of treatment. SIGNIFICANCE: To determine the clinical significance of the small improvement in mucociliary transport will require large clinical trials.

Administration, Intranasal↗

PubMed2003

Sinusitis update.

PURPOSE OF REVIEW: Rhinosinusitis affects more than 10% of the US population. It results in high health care expenditure as well as decreased productivity through lost days of school or work. This review includes recent findings in diagnostics and pathophysiology, as well as recent advances in treatment. RECENT FINDINGS: Parameters used in the diagnosis of rhinosinusitis include patient symptomatology, physical and endoscopic findings, computed tomography scan scores, and culture results. There has been poor correlation between patient symptoms and computed tomography scan scores, but middle meatal cultures have been shown to correlate well with ethmoid sinus cultures obtained from chronic rhinosinusitis patients. Chronic inflammation with a predominance of eosinophils and T lymphocytes in the tissues is being recognized as a hallmark of chronic rhinosinusitis, especially in patients with asthma or allergic rhinitis. Th2 cytokines are prominent in sinus tissues of patients with chronic rhinosinusitis and allergic rhinitis. While antibiotics are used with greater frequency in the treatment of acute and chronic rhinosinusitis, adjuvant therapies, such as intranasal steroids, might affect patient symptoms and curb disease recurrence. SUMMARY: Clinical symptoms are important in making the diagnosis of rhinosinusitis and should be supported by objective findings on nasal endoscopy and, if necessary, computed tomography scans. The mainstay of treatment remains antibiotics, with a potential role for decongestants and intranasal steroids. The presence of chronic inflammation with a Th2 cytokine predominance in sinus tissues should be kept in mind, especially in patients with coexistent morbidities such as allergic rhinitis and asthma.

Anti-Bacterial Agents↗

PubMed2003

Elevation of the nasal mucosal surface temperature after warming of the feet occurs via a neural reflex.

OBJECTIVE: To evaluate in humans the mechanisms underlying the increase in nasal mucosal temperature following immersion of the feet in warm water (42 degrees C). MATERIAL AND METHODS: The nasal mucosal temperature of subjects was measured whilst their feet were immersed in warm water. RESULTS: The nasal mucosal temperature rose quickly on immersion and dissipated equally fast on removal of the feet from warm water. Intranasal lidocaine raised the mucosal temperature slightly after application, but also blocked the feet warming-induced increase in nasal mucosal temperature, suggesting a neural reflex. Whereas the cutaneous-nasal reflex stimulates a transient parasympathetic response, acetylcholine does not seem to contribute to the more prolonged increase in nasal mucosal temperature following immersion of the feet in warm water. Warming of the feet probably leads to a loss of alpha-sympathetic activity of nasal blood vessels and an increase in nasal mucosal temperature because application of phenoxybenzamine, an alpha-sympathetic blocking agent, to the nasal mucosa increased the nasal mucosal temperature. CONCLUSIONS: Our data suggest that the increase in nasal mucosal temperature after warming of the feet is mediated by a neural reflex, which is caused by loss of sympathetic activity of the nasal vasculature and a possible additional contribution of a long-acting parasympathetic mediator.

Adrenergic alpha-Antagonists↗

PubMed2002

Effects of fexofenadine on the early response to nasal allergen challenge.

BACKGROUND: Previous studies using nasal allergen challenge models have shown that terfenadine, an H1 antihistamine, inhibits histamine release during the early response to allergen provocation. Fexofenadine, the active metabolite of terfenadine, has strong H1-antihistaminic activity and no cardiac effects. Clinical studies have documented the efficacy of fexofenadine in the treatment of allergic rhinitis. OBJECTIVE: To determine whether fexofenadine, like terfenadine, inhibits histamine and tryptase release during the early allergic response. METHODS: Randomized, double blind, placebo-controlled, two-way crossover study in 20 subjects with seasonal allergic rhinitis, out of their allergy season (median age 27.5 years, 13 males and 7 females). Subjects were medicated with either placebo or fexofenadine 180 mg orally daily for 1 week followed by nasal challenge with allergen. After each challenge, sneezes and nasal symptoms were recorded, and a nasal lavage was obtained for the assay of albumin, an indicator of vascular permeability, and histamine and tryptase, indicators of mast cell degranulation. RESULTS: When patients were on placebo, allergen challenges led to significant increases in all measured parameters compared with the sham challenges with diluent. Treatment with fexofenadine resulted in inhibition of allergen-induced symptoms and increased vascular permeability, but not the release of histamine and tryptase. CONCLUSION: Fexofenadine is an effective H1 antihistamine, but in contrast to its parent compound, terfenadine, it does not affect the release of the mast cell mediators histamine and tryptase.

Adolescent↗

PubMed2002

Effects of intranasal azelastine on the response to nasal allergen challenge.

OBJECTIVES/HYPOTHESIS: Azelastine, a second-generation H1-receptor antagonist, is available for topical administration. The aim of the study was to evaluate the effects of topical intranasal azelastine on the early-phase and the late-phase allergic responses and on nasal hyper-responsiveness to methacholine. STUDY DESIGN: Double-blind, placebo-controlled, two-way crossover study in 20 subjects with seasonal allergic rhinitis, out of their allergy season. METHODS: Subjects were randomly assigned to receive either placebo or two puffs of azelastine twice a day (548 microg/d) for 2 weeks followed by nasal challenge with allergen. Twenty-four hours later, while still receiving treatment, subjects underwent a nasal lavage and a nasal challenge with methacholine. End points included symptom scores, levels of mediators and number of eosinophils in nasal lavages, and the weight of secretions after methacholine challenge. RESULTS: Compared with placebo, treatment with intranasal azelastine resulted in significant reductions in allergen-induced sneezing, rhinorrhea, itching, nasal congestion, and levels of albumin during the early-phase response (P <.05). Azelastine had no effect on levels of histamine or tryptase during the early-phase response. There was a significant eosinophil influx 24 hours after challenge, which was not inhibited by azelastine. Treatment with azelastine had no effect on the levels of albumin, interleukin-4, interleukin-5, intercellular adhesion molecule-1, tumor necrosis factor-alpha, and eosinophil cationic protein during the late-phase response. However, azelastine did show a significant inhibitory effect on the methacholine response 24 hours after nasal allergen challenge (P <.05). CONCLUSIONS: The effects of intranasal azelastine are similar to those of oral second-generation antihistamines.

Adult↗

PubMed2002

Chronic sinusitis and allergic rhinitis: at the nexus of sinonasal inflammatory disease.

Allergic rhinitis and sinusitis are two very common diseases that affect the health of the American people and lead to a large amount of health care expenditure. Clinical observations support the close connection between these two diseases. We review existing evidence of the link between these two diseases, stressing the similarities in inflammatory responses between allergic rhinitis and sinusitis. Possible mechanisms underlying these relationships are described.

Animals↗