Biomedical subjects

J E Juto

Publications and source records attributed to J E Juto.

At least 19 recordsLinked to original sources

PubMed1999

Nasal and bronchial histamine reactivity in patients with allergic rhinitis out of season.

BACKGROUND: The correlation between non-specific hyperreactivity of upper and lower airways in pathologic conditions has not been studied extensively. OBJECTIVE: To investigate the occurrence of nasal and bronchial hyperreactivity in patients with allergic rhinitis studied out-of-season. METHODS: From patients admitted to the Allergy Unit at Stockholm Söder Hospital, 12 individuals with allergic rhinitis due to grass or birch pollen were selected. The nasal mucosa was exposed to increasing concentrations of histamine chloride and the response was recorded by rhinostereometry, an optical method that exclusively measures changes in nasal congestion. Bronchial histamine challenge was performed in connection with the nasal tests, but on different days. RESULTS: The nasal histamine response was significantly greater than in a reference group of healthy volunteers (P < .01). Nasal hyperreactivity was demonstrated in 9 of 12 patients. No clear relation between the magnitude of nasal and bronchial histamine responses was seen in the study group. CONCLUSIONS: In allergic rhinitis studied out-of-season, airway hyperreactivity is common in both upper and lower airways, but does not necessarily occur together in the same individual.

Adult↗

PubMed1995

Benzalkonium chloride in a decongestant nasal spray aggravates rhinitis medicamentosa in healthy volunteers.

A randomized double-blind parallel study with 20 healthy volunteers was performed to research the effect of a preservative in a decongestant nasal spray on the development of rhinitis medicamentosa. Ten subjects received oxymetazoline nasal spray with benzalkonium chloride and the others used oxymetazoline nasal spray without the preservative three times daily for 30 days. Before starting the course of treatment and after its conclusion, recordings of the mucosal surface positions were made with rhinostereometry followed by histamine challenge tests. Symptoms of nasal stuffiness were estimated on visual analogue scales (0-100) in the morning and the evening just before using the nasal spray. After 30 days, rebound swelling and nasal stuffiness were found in both groups. In the group receiving oxymetazoline nasal spray with benzalkonium chloride the mean rebound swelling was 1.1 mm and the estimated mean evening symptom score for nasal stuffiness was 43. In the group without benzalkonium chloride the corresponding variables were significantly less marked, with a mean rebound swelling of 0.5 mm (P < 0.05) and a mean evening symptom score of 25 (P < 0.05). The increase in histamine sensitivity in both groups was interpreted as a sign of nasal hyperreactivity. A new type of nasal spray bottle was used that has been shown to prevent bacterial contamination. In conclusion, the long-term use of benzalkonium chloride in oxymetazoline nasal spray accentuates the severity of rhinitis medicamentosa in healthy volunteers.

Administration, Intranasal↗

PubMed1995

The pathophysiology and treatment of rhinitis medicamentosa.

To evaluate the treatment of rhinitis medicamentosa, 10 consecutive patients discontinued their use of topical vasoconstrictors and were treated with budesonide nasal spray, 400 micrograms, daily for 6 weeks. The thickness of the nasal mucosa, the decongestive effect of oxymetazoline and the histamine sensitivity were measured with rhinostereometry. All patients were able to stop using the vasoconstrictors and objective variables showed that they needed treatment for at least 6 weeks. The results strongly support the theory that the rebound swelling is due to interstitial oedema rather than to vasodilatation. The presence of tachyphylaxis reflected by a reduction in both the decongestive effect of oxymetazoline and a reduction of drug duration was seen.

Administration, Topical↗

PubMed1995

Four-week use of oxymetazoline nasal spray (Nezeril) once daily at night induces rebound swelling and nasal hyperreactivity.

A randomized double-blind parallel study with 20 healthy volunteers was performed to examine the effect of oxymetazoline nasal spray on the development of rhinitis medicamentosa. For 30 days, 10 subjects were given oxymetazoline nasal spray once daily at night and placebo in the morning and at noon, while the others used oxymetazoline nasal spray three times daily. Before and after the course of treatment, the mucosal surface positions were determined with rhinostereometry, followed by histamine challenge tests. In the morning and the evening just before use of the nasal spray, symptoms of nasal stuffiness were evaluated on visual analogue scales (0-100). After 30 days, rebound swelling and nasal stuffiness were found in both groups. In the group receiving oxymetazoline nasal spray once daily at night, the mean rebound swelling was 0.8 mm (p < 0.01) and the estimated mean symptom score for nasal stuffiness in the evening was 43 (p < 0.05). In the group receiving the same nasal spray three times daily, the mean rebound swelling was 1.1 mm (p < 0.01) and the mean evening symptom score was 43 (p < 0.05). The finding of an increase in histamine sensitivity in both groups was taken to indicate nasal hyperreactivity. There was no significant difference in the investigated variables between the two groups. It is concluded that the risk of developing rebound swelling and nasal hyperreactivity remains, whether oxymetazoline nasal spray is used once or three times a day for 30 days.

Administration, Intranasal↗

PubMed1995

Sustained use of xylometazoline nasal spray shortens the decongestive response and induces rebound swelling.

Long-term use of topical vasoconstrictors for the nose may result in rhinitis medicamentosa, drug addiction and tachyphylaxis. Some authors also believe that the severity of rebound swelling is proportional to the period during which the drug has been used, the frequency of its administration, and the amount of drug given. It has previously been reported that four-week use of the recommended dose of oxymetazoline induces rebound swelling, a sign of rhinitis medicamentosa. To study the effect of an increased amount of vasoconstrictor on rebound swelling and the decongestive effect of the drug, nine healthy subjects were given xylometazoline nasal spray in double the recommended dose (1.0 mg/ml; 0.28 ml in each nostril thrice daily) for 30 days. After 30 days on xylometazoline, the decongestive effect was the same 1 h after drug administration as before starting the medication. Similarly, after 30 days on xylometazoline, the decongestive effect was less 5 h after drug administration than it was 6 h after drug administration at the start of medication (p < 0.005). After 10 days no rebound swelling was recorded, but after 30 days rebound swelling occurred in eight out of nine subjects (p < 0.05). When comparing the results of this trial with the corresponding results of the oxymetazoline study, no further increase in rebound swelling was found. We conclude that long-term use of xylometazoline nasal spray shortens the decongestive response in healthy volunteers. Moreover, double the recommended dose of xylometazoline did not further increase the rebound swelling seen when using the recommended dose of oxymetazoline.

Adolescent↗

PubMed1994

Correlation between subjective and objective assessment of nasal hyperreactivity.

The aim of this study was to investigate if there is a correlation between symptom score and response to histamine challenge in patients suffering from non-allergic nasal hyperreactivity. Eighteen patients with perennial rhinitis entered the trial. All had negative skin prick tests and normal total IgE. The nasal mucosa was challenged with three histamine concentration levels, 1, 2 and 4 mg/ml. The objective response was recorded with rhinostereometry and was compared to symptom scores estimated by the patients on a visual analogue scale. With simple analysis of regression there was a significant correlation when challenging with 2 mg/ml (R = 0.695, p < 0.01) and 4 mg/ml (R = 0.569, p < 0.05). The results indicate that the model could be useful for objective assessment of the degree of non-allergic nasal hyperreactivity.

Adolescent↗

PubMed1994

Histamine sensitivity in the nasal mucosa during four-week use of oxymetazoline.

In order to objectively study the histamine sensitivity of the nasal mucosa during 30 days of regular use of oxymetazoline nasal spray (0.5 mg/ml; 0.1 ml in each nostril, thrice daily), eight healthy volunteers were examined with rhinostereometry. After 10 days on being treated, the histamine sensitivity was slightly enhanced. After a further 20 days the sensitivity was significantly increased compared to that before the start of the medication (p < 0.05). This increase in histamine sensitivity for the group is significantly greater than that of healthy drug-free volunteers, and the level is comparable with that of patients with non-allergic nasal hyperreactivity (NANH). It is concluded that a hyperreactive mucosal reaction develops after a relatively short time on oxymetazoline and that the results of this study are in line with the recommendation that the drug should not be used for more than 10 days.

Administration, Intranasal↗

PubMed1993

A test for objective diagnosis of nasal hyperreactivity.

The aim of this study was to develop a method for the objective diagnosis of nasal hyperreactivity. The method should be standardized and simple enough to be used in clinical practice. In the study nasal challenge test with histamine was performed. Ten healthy volunteers and ten patients with a history of nasal hyperreactivity entered the trial. Recordings of nasal mucosa congestion were made with rhinostereometry. The results indicate that this method can indeed be used for the objective diagnosis of nasal hyperreactivity.

Adult↗

PubMed1993

Nasal hyperreactivity. A histamine provocation model.

The aim of the study was to see whether it is possible to select non-allergic persons with hyperreactivity, especially in the nose, from healthy individuals with a histamine standardization test. Another aim was to elucidate whether a so-called priming effect could be present in such a non-allergic disorder. Seven patients with a history of perennial rhinitis, expressed as either or both swelling or discharge from the nose and a negative allergic investigation, were examined on three up to seven consecutive occasions. Rhinostereometry was used to register the reaction in the mucous membrane to a solution of histamine in successively increased concentrations. The results showed a statistically significant difference between this group compared with a control group of healthy volunteers. We could not detect any increase in the sensitivity during repeated provocations.

Adolescent↗

PubMed1992

Nasal mucosa reaction. A model for mucosal reaction during challenge.

Rhinological symptoms in aspects of hyperreactivity and allergy are increasing problems. Previous reports on this subject are based on studies of airway obstruction (rhinomanometry), secreted substances during challenge, and symptom scores. To be able to define and evaluate the pathological reactions in nasal hyperreactivity and allergy, it is necessary to find principles to describe and standardize the reactions of the healthy nasal mucosa. The aim of this study was to examine congestion of the nasal mucosa in healthy volunteers. Existing measuring methods, in this aspect, are either indirect or not accurate enough for this purpose. With the development of rhinostereometry, an optical measuring method, it is possible to record nasal mucosa congestion with high accuracy. A nasal challenge test was made in healthy volunteers with gradually raised concentrations of a histamine solution, which was applied to the inferior concha on the right side. Recordings of the mucosal congestion were made with rhinostereometry. We found that it is possible, with statistical significance, to standardize the reactions of the healthy nasal mucosa: There is no congestion more than 0.4 mm with a histamine concentration of less than 4 mg/ml (p less than 0.05); congestion of more than 0.4 mm is present at histamine concentrations of 16 mg/ml (p less than 0.05).

Adult↗

PubMed1985

Human nasal mucosa reaction during chilling of the feet.

As rhinostereometry, an optical measurement method, allows meticulous studies of changes in nasal mucosa congestion, the mucosal reaction in eight healthy volunteers was studied with this technique before, during and after 20 minutes' chilling of the feet in cold water. In five volunteers there were no observable mucosal reactions. In three volunteers the mucosal congestion changed but not uniformly, and not in such a way that the change could be explained as an effect of chilling of the feet. In four volunteers there was a clearly observable increased nasal secretion. This gives a possible explanation of the increased nasal breathing resistance observed in similar studies using rhinomanometry as the measuring method.

Adult↗

PubMed1983

Methods for standardization of nasal mucosa decongestion in man.

As physical exercise has been shown to reduce nasal breathing resistance, the effect of physical exercise on the nasal mucosa congestion was studied, using rhinostereometry, an optical measurement method. Submaximal physical exercise as well as oximetazolinechloride sprayed into the nose, caused mucosal decongestion but the stimuli were not strong enough invariably to produce maximal mucosal decongestion as studied in 16 volunteers at repeated tests. Maximal physical exercise as well as oximetazolinechloride applied to the mucosa on a soaked piece of cottonwool, caused a considerable (0.5-4.1 mm) decongestion. Furthermore, in each of the 8 studied volunteers the final position of the mucosal surface was the same in repeated tests. Thus, this mucosal surface position can be considered as the state of maximal decongestion and can in physiological and pharmacological studies be used as reference position.

Adult↗

PubMedDate not supplied

An objective method to record changes in nasal reactivity during treatment of non-allergic nasal hyperreactivity.

Non-allergic nasal hyperreactivity is a common problem and many patients suffer from daily symptoms demanding medication. Hitherto there exists no objective method to study congestional changes in clinical practice, to evaluate the efficacy of different therapies. This study is an attempt to develop a method for this purpose. Eleven patients with non-allergic nasal hyperreactivity entered the trial. A histamine challenge model with three different histamine concentrations was used. Recordings of the reactivity of the nasal mucosa were made with rhinostereometry before and after 14 days of topical treatment with budesonide 200 micrograms/day. The results were compared to symptom scores before and after treatment. It was found that there was a significant improvement after treatment both with regard to symptom score and to the recorded reactivity of the nasal mucosa. There was a correlation between symptom score and recorded reactivity before treatment, but not after treatment. The results indicate that the symptom score technique is sufficient in situations where only a semiquantitative method is required. However, when studying changes in the degree of hyperreactivity, the demands for an objective measuring method is greater. The study indicates that the presented method may be adapted for this purpose.

Administration, Topical↗

PubMedDate not supplied

Decongestion effect and rebound swelling of the nasal mucosa during 4-week use of oxymetazoline.

The aim of this study was to investigate whether long-term use of oxymetazoline induces a rebound swelling of the nasal mucosa and whether the decongestion effect is altered during medication. Eight healthy volunteers had oxymetazoline nasal spray (0.5 mg/ml; 0.1 ml in each nostril, three times daily) for 30 days and registrations of the mucosal surface positions were made using rhinostereometry. Compared to the registrations before the start of medication, no rebound swelling was registered after 10 days. After 30 days, however, a rebound swelling was registered in all subjects (p < 0.001). All of them, then, also reported nasal stuffiness. The decongested position of the nasal mucosa after one single dose of oxymetazoline was the same in the whole study. It is concluded that rhinitis medicamentosa develops after a relatively short time on oxymetazoline, even in healthy volunteers, and that the swelling probably is due to a vasodilatation rather than an edema. The study supports the recommendation that the drug should not be used over periods > 10 days.

Adult↗

PubMedDate not supplied

The nasal reactivity in patients with nasal polyps.

Nasal polyposis is a common clinical problem. The polyps commonly arise from the ethmoid sinuses and the etiology is still poorly understood. There is a connection between nasal polyps and asthma, cystic fibrosis and aspirin intolerance, but it is unclear whether there is a connection between nasal polyps and nasal hyperreactivity. The aim of this study was to investigate whether there is a connection between nasal hyperreactivity and nasal polyposis. Ten patients with nasal polyposis entered the trial. The nasal reactivity was studied with rhinostereometry during provocation with histamine. It was found that the patients with polyps did not have any nasal hyperreactivity.

Adolescent↗

PubMedDate not supplied

Correlation between objective nasal mucosal swelling and estimated stuffiness during long-term use of vasoconstrictors.

The correlation between nasal mucosal swelling and estimated stuffiness was evaluated in 13 healthy volunteers who entered the trial. The nasal mucosa was challenged with increasing concentrations of histamine solutions. The amount of mucosal swelling was recorded using rhinostereometry, and the stuffiness was estimated by the subjects on a visual analogue scale. Then the subjects were randomly chosen to receive either oxy- or xylometazoline nasal spray for 30 days. After 10 days on the drug, the histamine sensitivity was enhanced, and after another 20 days, it had increased further, reflecting the development of rhinitis medicamentosa. Before the subjects started the nasal spray and after 10 days on the drug, a correlation between stuffiness and swelling was seen in the individual subject only when the degree of stuffiness almost obliterated the nasal opening. At the end of the month, no correlation was present. In all histamine provocations throughout the month, a very high correlation was noted between mean mucosal swelling and mean stuffiness. It is concluded that the symptom scores for nasal obstruction are useful for determining nasal mucosal swelling in groups. However, in the individual subjects one can estimate the mucosal swelling only when the amount of swelling almost obliterates the nasal opening. This cannot be done when the mucosa is hyperreactive.

Drug Eruptions↗

PubMedDate not supplied

Airway reactivity of nose and bronchi in patients with nasal polyps.

The aim of the study was to determine whether patients with nasal polyps have a hyperreactive nasal mucosa and/or bronchi and whether there is any correlation between nasal and bronchial hyperreactivity. Twenty-six healthy volunteers and 10 consecutive patients with nasal polyps participated in the study. They were challenged with increasing concentrations of histamine. The nasal mucosa response was studied with rhinostereometry and the bronchial response was estimated by peak flow. One of the patients was mildly hyperreactive in the nose and 6 patients were hyperreactive in the bronchi. There was no correlation between nasal and bronchial hyperreactivity. Patients with nasal polyps do not have a hyperreactive nasal mucosa but there seems to be a high incidence of bronchial hyperreactivity in patients with nasal polyps.

Adult↗

PubMedDate not supplied

Rhinostereometry and laser Doppler flowmetry in human nasal mucosa: changes in congestion and microcirculation during intranasal histamine challenge.

The nasal mucosa of 10 healthy volunteers was studied with the combination of rhinostereometry and laser Doppler flowmetry during a challenge with 0.14 ml histamine dihydrochloride in stepwise increasing concentrations of 0.5, 1.0, 2.0, 4.0, 8.0 and 16.0 mg/ml. Five and 10 min after each challenge the degree of congestion and the microcirculatory parameters perfusion, velocity of flow and concentration of moving blood cells were recorded. A complex reaction pattern was seen. It was possible to measure simultaneously the degree of congestion and the microcirculatory parameters. With this combination of methods, it seemed possible to identify the effects of histamine on the different components of the nasal mucosa. The combination of the two methods appears to make possible detailed studies of the relationship between changes in congestion and microcirculation during intranasal challenges in humans.

Administration, Intranasal↗