The correlation between chronic sinonasal inflammation and nasopharyngeal carcinoma

In a recent systematic review and meta-analysis, the presence of chronic sinonasal inflammation shows a significant correlation with nasopharyngeal carcinoma. Findings of this study were documented in the American Journal of Otolaryngology.

This meta-analysis involved a comprehensive search of four international databases from 1^st January 1973 to 28^th March 2022 for studies addressing sinonasal inflammation and NPC in adults (greater than 18 years old). Case-control, cohort, or cross-sectional studies were included that explored the association between a prior history of sinonasal inflammation and the risk of developing NPC. The incidence of nasopharyngeal carcinoma (NPC) in patients with prior sinonasal inflammation is the outcome.

A total of eight studies, comprising 8,245 individuals diagnosed with NPC and 1,036,087 individuals without NPC, were examined. The overall odds ratio for developing NPC following sinonasal inflammation was found to be 1.81 (95% confidence interval 1.73-1.89). Chronic rhinosinusitis (CRS) exhibited a stronger association with an increased risk of NPC, with an odds ratio of 1.78 (95% confidence interval: 1.68-1.90), in comparison to allergic rhinitis (AR) (odds ratio of 1.60; 95% confidence interval: 1.52-1.68).

Thus, it can be concluded that chronic sinonasal inflammation is strongly linked to nasopharyngeal carcinoma. It is important to thoroughly examine the cause-and-effect relationship and the potential effects of targeted screening using large-scale prospective studies.

The causal associations between metabolites and allergic diseases

Recent research demonstrated that imbalances in multiple circulating and urinary metabolites could be associated with the development and progression of allergic diseases. These findings are important for devising targeted strategies for both the prevention and treatment of allergic conditions. The results of this study were documented in the journal Respiratory Research. 
A two-sample Mendelian Randomization (MR) analysis was undertaken to examine possible causal associations between circulating and urinary metabolites and allergic diseases. The exposures were obtained from a genome-wide association study (GWAS) that included four hundred and eighty-six circulating metabolites, as well as a GWAS that targeted fifty-five urinary metabolites. Outcome data related to allergic diseases, including atopic dermatitis (AD), asthma, and allergic rhinitis (AR) were sourced from the FinnGen biobank in Europe (Cohort 1) and the Biobank Japan in Asia (Cohort 2). The MR findings from both cohorts were integrated through a meta-analysis.
The analysis utilizing MR identified a total of six urinary metabolites and fifty circulating metabolites in Cohort 1, alongside two urinary metabolites and fifty-four circulating metabolites in Cohort 2, which may have a causal relationship with allergic diseases. A subsequent meta-analysis of the MR findings highlighted 1-arachidonoylglycerophosphoinositol (odds ratio 2.178; 95% confidence interval 1.388-3.419; P value = 7.15E-04) and stearoylcarnitine (odds ratio 8.654; 95% confidence interval 4.399-17.025; P value = 4.06E-10) as the most significant causal circulating metabolites associated with allergic rhinitis (AR) and asthma, respectively. Additionally, tyrosine (odds ratio 0.601; 95% confidence interval: 0.380-0.952; P value = 0.030), histidine (odds ratio 0.734; 95% confidence interval: 0.594-0.907; P value = 0.004) and alanine (odds ratio 0.280; 95% confidence interval: 0.125-0.628; P = 0.002) were identified as urinary metabolites that provide the most substantial protective effects against atopic dermatitis (AD), asthma, and AR, respectively.
Thus, it can be concluded that imbalances in multiple circulating and urinary metabolites may be associated with the onset and advancement of allergic conditions. The implications of these results are important for creating targeted interventions for both the prevention and treatment of allergic conditions.
 

The combination of omalizumab and allergen immunotherapy compared to immunotherapy alone for the treatment of allergic diseases

The combination of omalizumab and allergen immunotherapy (AIT) can effectively enhance the overall efficacy and safety of AIT by increasing the target maintenance dose (TMD) and the sustained unresponsiveness (SU), while also lowering the risk of severe systemic adverse effects. The findings of the study have been published in the International Forum of Allergy & Rhinology.

The Cochrane Library, MEDLINE/PubMed, Scopus, and Embase databases were thoroughly examined to identify randomized controlled trials that investigated the effects of omalizumab combined with allergen immunotherapy in comparison to allergen immunotherapy by itself. To estimate the outcomes, a random-effects model was established with a 95% confidence interval.

Eleven eligible randomized controlled trials, involving a total of nine hundred and one patients, were included in the meta-analysis. The results of the pooled analysis indicated that the combination of omalizumab and AIT significantly improved the count of patients achieving the TMD and SU to allergens, with odds ratios (OR) of 2.43 (95% confidence interval: 1.33-4.44; p value = 0.004; I2 = 35%) for TMD and odds ratio of 6.77 (95% confidence interval: 2.10-21.80; p value = 0.001; I2 = 36%) for SU. In addition, patients receiving the combination therapy reported a significantly lower incidence of severe systemic adverse events compared to those treated with AIT alone, with an odds ratio of 0.32 (95% confidence interval: 0.18-0.59; p value = 0.0003; I2 = 0%). Additionally, improvements in daily rescue medication scores (mean difference [MD] = -0.14), symptom severity score (MD = -0.26), and the incidence of epinephrine use in AIT (odds ratio = 0.20) were considerably more apparent than those in allergen immunotherapy by itself.

The above study showed that the use of omalizumab alongside allergen immunotherapy can substantially boost the efficacy and safety of AIT. This combination allows for an increase in the TMD and SU, while also decreasing the chances of experiencing severe systemic adverse effects.

The beneficial properties of a standardized Nigella sativa oil containing 5% thymoquinone in alleviating seasonal allergy symptoms

A recent study demonstrated that the use of Nigella sativa oil (NSO) 250 mg along with 2.5 mg of piperine is an effective and well-tolerated approach for managing the symptoms of allergic rhinitis. This study’s findings were presented in the journal Medicine.

A double-blind, randomized, placebo-controlled study was performed with 65 individuals aged 18 to 60 years, all of whom presented with two or more allergic symptoms, including rhinorrhoea, nasal obstruction, sneezing, and nasal itching for a cumulative duration exceeding one hour each day. A total of 33 participants were assigned to the NSO group, while 32 were placed in the placebo group. Participants were assigned to receive either a 250 mg NSO capsule combined with 2.5 mg of piperine (BioPerine) or a placebo, taken twice daily after meals for a total duration of 15 days. The primary objectives were assessed by evaluating the mean change in the duration of allergic rhinitis symptoms per day and the Total Nasal Symptom Score from the baseline to Day 15. Secondary endpoints included changes in the Total Ocular Symptoms Score, severity and frequency of allergic rhinitis symptoms, serum Immunoglobulin E levels, and the Patient Global Impression of Change scale. Continuous monitoring of adverse events was maintained throughout the study period.

A significant reduction in both the Total Ocular Symptoms Score and the Total Nasal Symptom Score was noted in the NSO group compared to the placebo, highlighting the potential effectiveness of NSO in alleviating symptoms of allergic rhinitis. Both groups experienced a significant decrease in the daily occurrence of AR symptoms and their frequency over a 24-hour period within 15 days; however, the NSO group showed a considerably greater improvement. The Patient Global Impression of Change also indicated a significantly more favorable outcome for the NSO group compared to the placebo. Serum immunoglobulin E levels in the NSO group showed a decline, yet this change was not significantly different from the results recorded in the placebo group. Additionally, no clinically significant changes were detected in vital signs, liver and renal function, fasting blood sugar, lipid profiles, hematological assessments, or urine analysis at the study's conclusion.

Thus, it can be concluded that NSO at 250 mg alongside 2.5 mg of piperine is an effective and well-tolerated option for the management of allergic rhinitis symptoms.

The role of intranasal antihistamines and corticosteroids in the management of allergic rhinitis

According to recent study, most intranasal medications have proven effective in mitigating rhinitis symptoms and enhancing quality of life. The findings of this research have been published in The Journal of Allergy and Clinical Immunology.

Four electronic bibliographic databases and three clinical trials databases were systematically searched for randomized controlled trials that (1) focused on adult patients with seasonal or perennial allergic rhinitis (AR) and (2) compared the effects of intranasal antihistamines or corticosteroids with those of a placebo. The outcomes assessed included the Total Ocular Symptom Score, the Total Nasal Symptom Score, and the Rhinoconjunctivitis Quality-of-Life Questionnaire. The mean differences for each medication and outcome were determined using random-effects meta-analyses. The certainty of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) framework.

In this review, 151 primary studies were evaluated, primarily focusing on patients diagnosed with seasonal allergic rhinitis, with many of these studies showing either unclear or high levels of bias risk. In both perennial and seasonal AR cases, the majority of evaluated treatments proved to be more effective than placebo. For seasonal AR, fluticasone furoate, azelastine-fluticasone, and fluticasone propionate were identified as the medications with the highest likelihood of achieving moderate to significant improvements in the Rhinoconjunctivitis Quality-of-Life Questionnaire and the Total Nasal Symptom Score. Azelastine-fluticasone, in particular, showed the highest probability of leading to moderate or substantial improvements in the Total Ocular Symptom Score. The overall certainty of evidence was classified as "high" in 6 of the 46 analyses, "moderate" in 23 of the 46 analyses, and "low" or "very low" in 17 of the 46 analyses.

The above study highlighted the effectiveness of intranasal medications in reducing rhinitis symptoms and improving quality of life. However, it is important to note that there are relevant differences in the associated evidence of certainty with these treatments.