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Biomedical subjects

G Scadding

Publications and source records attributed to G Scadding.

At least 19 recordsLinked to original sources
PubMed2006

Prevalence of hyperventilation syndrome in an allergy clinic, compared with a routine ENT clinic.

OBJECTIVES: A high prevalence of chronic hyperventilation syndrome in patients with asthma has been reported. We examined whether this phenomenon extended to allergy clinic patients in general and whether the prevalence was higher in patients attending a general allergy clinic compared with those attending a routine ENT clinic in our hospital. METHODS: We examined the prevalence of hyperventilation syndrome in unselected, consecutive patients (n = 100) seen in an allergy clinic. The validated Nijmegen questionnaire was completed by patients in the waiting room. We also administered the questionnaire to unselected, consecutive patients (n = 100) in a routine ENT clinic. RESULTS: There was no significant difference in prevalence of hyperventilation between allergy clinic and routine ENT clinic patients (25/100 vs 23/100). CONCLUSION: The result indicates a high prevalence of hyperventilation amongst hospital attendees in general. Consideration should perhaps be given to the possible role of hyperventilation in symptomatology.

Adolescent↗
PubMed2006

Nasal nitric oxide in objective evaluation of chronic rhinosinusitis therapy.

BACKGROUND: The assessment of the response of chronic rhinosinusitis (CRS) to therapy is difficult. Computerized tomographic (CT) scans cannot be repeatedly used so measures such as symptom scores, endoscopic findings, and parallel measures such as saccharin clearance time are employed instead. OBJECTIVE: To study the effect of CRS therapy on nasal nitric oxide and to see whether nasal nitric oxide level changes correlate with other assessments. METHODS: The study was a prospective randomized trial of patients with CRS, with or without polyps, who had failed initial medical therapy with douching and nasal corticosteroids and who then had abnormal CT scans. They were treated either medically or surgically, with follow up at 6 and 12 months whilst still taking nasal corticosteroids. Nasal nitric oxide was measured initially and at 6 and 12 months as well as symptom scores, endoscopy, polyp grading, and saccharin clearance time. RESULTS: Initial absolute nasal nitric oxide levels correlated inversely with CT scan changes, (P<0.001). The percentage rise in nasal nitric oxide seen on both medical and surgical treatment correlated with changes in symptom scores (P<0.001), saccharin clearance time (P<0.001), endoscopic changes (P<0.001), polyp grades (P<0.05 at 6 months, P<0.01 at 12 months) and surgical scores (P<0.01). There was no significant correlation with age, sex, smoking or allergy. CONCLUSION: Nasal nitric oxide, which is easily measured, provides a valuable non-invasive objective measure of the response of CRS to therapy. Topical nasal corticosteroids may be needed to reduce the contribution of nasal epithelial nitric oxide and allow that emanating from the sinuses to be measured.

Administration, Intranasal↗
PubMed2006

Pharmacologic and anti-IgE treatment of allergic rhinitis ARIA update (in collaboration with GA2LEN).

The pharmacologic treatment of allergic rhinitis proposed by ARIA is an evidence-based and step-wise approach based on the classification of the symptoms. The ARIA workshop, held in December 1999, published a report in 2001 and new information has subsequently been published. The initial ARIA document lacked some important information on several issues. This document updates the ARIA sections on the pharmacologic and anti-IgE treatments of allergic rhinitis. Literature published between January 2000 and December 2004 has been included. Only a few studies assessing nasal and non-nasal symptoms are presented as these will be discussed in a separate document.

Animals↗
PubMed2005

Oral antihistamines for the symptom of nasal obstruction in persistent allergic rhinitis--a systematic review of randomized controlled trials.

BACKGROUND: Oral antihistamines are recommended by a World Health Organisation working group as a first-line pharmacological treatment in mild persistent allergic rhinitis. There is, however, uncertainty with respect to their effectiveness for a common symptom, that of nasal obstruction. OBJECTIVE: To test the null hypothesis that oral antihistamines have no effect on the symptom of nasal obstruction in a clinical setting in patients with persistent allergic rhinitis. METHODS: Protocol based review of double-blind randomized controlled trials of oral antihistamine (i.e. drugs considered to act as a histamine receptor type-1 antagonist) vs. placebo. A search was carried out for published and unpublished trials. Individuals had to be age 12 years or older (with a diagnosis confirmed by skin prick tests, IgE blood tests or nasal allergen challenge), experiencing their normal allergen exposure. A symptom score for nasal obstruction had to be recorded. Predetermined quality criteria were applied. Treating their data as 4-point scores, a meta-analysis was carried out for studies, which provided enough data to be pooled. RESULTS: Meta-analysis found a weighted mean difference of -0.52 in favour of treatment for patient-assessed symptom scores (95% confidence interval (CI)-0.73,-0.31, P<0.00001), and of -0.33 in favour of treatment for healthcare worker assessed scores (95% CI -0.49, -0.16, P = 0.0001). CONCLUSION: Oral antihistamines cause statistically significant improvement in the symptom of nasal obstruction in patients with persistent allergic rhinitis.

Administration, Oral↗
PubMed2003

The management of idiopathic olfactory hallucinations: a study of two patients.

OBJECTIVES/HYPOTHESIS: Idiopathic olfactory hallucination is a rare condition. We report two cases of idiopathic olfactory hallucination and a review of the literature that relates to this condition. STUDY DESIGN: A retrospective case study of two patients with idiopathic olfactory hallucination. METHODS: Records of two patients were retrospectively reviewed. RESULTS: The diagnosis of idiopathic olfactory hallucination was confirmed after excluding any intranasal disease or any central nervous system disorder discernible by an electroencephalogram and magnetic resonance imaging. Both patients were successfully treated with sodium valproate. One patient stopped taking sodium valproate because of side effects, only for the symptoms to return, but these were then controlled by phenytoin sodium. The mean patient follow-up time was 3 years 5 months. CONCLUSIONS: The symptoms of some cases of idiopathic olfactory hallucination may be controlled by sodium valproate or phenytoin sodium. We hypothesize that this disorder may be a central phenomenon attributable to reverberating circuits.

Adult↗
PubMed2001

The prevalence of atopic disorders in children with chronic otitis media with effusion.

We studied 209 children, referred to a multi-disciplinary 'Glue ear/Allergy' clinic at our hospital with a history of chronic or recurrent otitis media with effusion (OME), in order to determine the prevalence of atopic disease in this population. Referrals were made either from within the hospital by Ear, Nose and Throat (ENT) Surgeons and Audiological Physicians (internal), or by General Practitioners (external). Assessment of atopic status was based on medical history, physical examination, nasal smears and skin-prick testing (SPT) in all children; and on blood eosinophil counts and total immunoglobulin E (IgE) levels in a randomly selected subset. The main outcome measures were number of children with rhinitis, asthma, eczema, positive SPT, raised IgE level (> 100 IU/l), and nasal and blood eosinophilia. We found allergic rhinitis in 89%, asthma in 36%, and eczema in 24%. SPTs were positive to one or more of eight common inhalant aeroallergens in 57% of children. Blood tests in the selected subset revealed eosinophilia in 40% and a raised serum IgE in 28%. The worldwide prevalence of allergic rhinitis in children has been estimated to be 20%. The 89% prevalence found in this study is very high and there are a number of reasons which suggest that there may be a causal relationship. Whole-population studies will be required to confirm these findings, which could have important therapeutic implications for OME.

Allergens↗
PubMed2001

Role of kinins in seasonal allergic rhinitis: icatibant, a bradykinin B2 receptor antagonist, abolishes the hyperresponsiveness and nasal eosinophilia induced by antigen.

BACKGROUND: Icatibant, a bradykinin B(2) receptor antagonist, inhibits the reduction in nasal patency after challenge with house dust mite antigen in sensitive subjects and abolishes the nasal hyperresponsiveness induced by platelet-activating factor in nonatopic subjects. OBJECTIVE: We sought to investigate the effect of icatibant on the response to nasal antigen challenge in subjects with seasonal allergic rhinitis. METHODS: Patients allergic to grass pollen antigen (n = 9-13) were included in a double-blind, randomized-block, placebo-controlled, crossover study outside the pollen season. Subjects first received an intranasal spray of icatibant (200 microg per nostril) or a saline control. Subjects were then challenged with antigen or diluent (control), and their responses were monitored by using acoustic rhinometry. Six hours later, nasal lavage fluid was collected and quantified for inflammatory cells and various inflammatory mediators (kinin, eosinophil cationic protein, IL-5, and IL-8). At 24 hours, the response of the nasal airways to 200 microg of histamine was assessed, and a further nasal lavage was carried out. RESULTS: Antigen challenge caused a significant increase in nasal obstruction and albumin extravasation, which was not affected by icatibant. Nasal hyperresponsiveness to histamine was present 24 hours after antigen and was abolished by pretreatment with icatibant. Icatibant also reduced the antigen-induced increase in eosinophils, eosinophil cationic protein, kinin, and IL-8 in nasal lavage fluid. CONCLUSION: Pretreatment with icatibant does not affect the acute inflammatory response in seasonal allergic rhinitis. However, our results imply the involvement of kinins and the bradykinin B(2) receptor in the development of antigen-induced hyperresponsiveness and the associated eosinophilia in the human nasal airway.

Adult↗
PubMed1999

Nasal douching as a valuable adjunct in the management of chronic rhinosinusitis.

The effect of nasal douching in 40 patients with chronic rhinosinusitis was tested, and two different preparations compared: 19 receiving traditional alkaline nasal douche and 21 receiving a sterile sea water spray, in addition to their regular treatment. Douching per se improved endoscopic appearances (p = .009), and quality of life scores (p = .008). These measures did not change in a control group (n = 22) who received standard treatment for chronic rhinosinusitis, but no douche. There were significant differences between the two douching preparations in that the alkaline nasal douche improved endoscopic appearances but not quality of life, whereas the opposite was true for the spray.

Adolescent↗
PubMed1997

Immediate and short-term effects of benzalkonium chloride on the human nasal mucosa in vivo.

The in vivo effects of benzalkonium chloride, which is a preservative in most nasal sprays and drops, have been investigated in normal human volunteers. Saccharin clearance time was slightly prolonged 10 min after 0.02% benzalkonium chloride was applied, compared to that following 0.9% saline (n = 27, P = 0.04, Wilcoxon test). Sixty-five normal volunteers were randomly assigned to receive saline, fluticasone propionate aqueous nasal spray or placebo (which contained all the ingredients of fluticasone aqueous spray incl. 0.02% benzalkonium chloride, minus the fluticasone propionate) for 2 weeks, two puffs twice a day on a double-blind basis. Symptom scores, acoustic rhinometry, saccharin clearance time and ciliary beat frequency were measured immediately prior to this study and again at 2 weeks. Fifty-eight individuals completed the study with > 80% compliance. There was no significant difference between the three groups in any of the variables tested. Benzalkonium chloride causes slight prolongation of mucociliary clearance shortly after application but has no detectable effect on nasal mucosal function after 2 weeks regular use.

Adult↗
PubMed1995

Intranasal salbutamol has no effect on mucociliary clearance in normal subjects.

Normal mucociliary clearance is essential for the healthy function of the upper and lower airways. Restoring normal clearance times in the presence of chronic disease would be a helpful adjunct in treating these patients. This double-blind placebo-controlled trial in 37 normal subjects compared topical salbutamol against placebo on nasal mucociliary clearance. Clearance rates were measured using the sacharine clearance technique and 34 patients completed the study. There was no effect of treatment, sex, order of treatment or period (interval between treatments) on mucociliary times. There was a weak positive correlation with age and there was a trend towards increased clearance times with salbutamol although this did not reach significance (P = 0.226). The results show that topical salbutamol appears to have no effect on nasal mucociliary clearance times in vivo in normal subjects.

Administration, Intranasal↗
PubMed1992

Eosinophilia in nasal secretions compared to skin prick test and nasal challenge test in the diagnosis of nasal allergy.

This study was aimed to assess the usefulness of eosinophilia measurements in nasal smears (ENS) in the diagnosis of nasal allergy. Nasal smears were taken from 84 patients with histories suggestive of allergic rhinitis. The smears were stained by the Giemsa method and examined by light microscopy. Positive results were demonstrated in 69.2% of the samples. All the 84 patients also had a skin prick test (SPT); the perceniitage of correct correlation between ENS and SPT was 71.4%. Forty-two patients underwent nasal challenge test (NCT) and the percentage of correct correlation between ENS and NCT was 69%. Nine patients had negative SPT, but positive ENS. All were nasally challenged with 4 proving positive. This leaves 5 individuals (5.9% of the 84 studied) in the non-allergic rhinitis with eosinophilia category. Based on these findings, it is suggested that the assessment of eosinophils in nasal smears should be given more relevance and be more commonly used in the diagnosis of nasal allergy.

Adult↗