Relationship between nasal mucociliary clearance and disease severity in children with allergic rhinitis: A comparative cross-sectional study

Main Article Content

S.B. Batmaz
S. Alicura Tokgöz

Keywords

Mucociliary, Pediatrics, Saccharin

Abstract

Objectives: Mucociliary clearance (MCC) is impaired due to chronic inflammation in allergic rhinitis. Our aim was to evaluate MCC in children with allergic rhinitis, to determine its relationship with disease severity and evaluate MCC change after nasal irrigation.


Materials and methods: Saccharin test was performed in 51 patients with allergic rhinitis and in 50 controls. Nasal irrigation was performed to the patients and saccharin test was repeated at the 10th minute. Total nasal symptom score (TNSS) and visual analogue scale (VAS) results were recorded. Patients were divided into mild/moderate-severe groups according to TNSS, VAS, and ARIA guidelines. Nasal MCC time (NMCCT) of the patients and the controls and NMCCT before and after nasal irrigation of the patients were compared. Correlations between NMCCT and TNSS/VAS were evaluated. NMCCTs of the mild and moderate-severe groups were compared. The cut-off values were calculated to discriminate the patient group.


Results: The mean NMCCT of the patient group was higher than the controls. Mean NMCCTs were different between before and after irrigation. NMCCT was higher in uncontrolled/moderate-severe groups than in controlled/mild groups. NMCCT correlated positively with VAS and TNSS. The sensitivity and specificity of NMCCT > 535 s were found to be 86.27% and 94%, respectively.


Conclusions: In children with allergic rhinitis, the prolongation of MCC may be identified with the easily applicable saccharin test, the deterioration in MCC increases as disease severity increases. Nasal irrigation is important in children with allergic rhinitis to improve MCC.

Abstract 339 | PDF Downloads 236

References

1. Bro˙zek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140:950-8.

2. Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006;368:733-43.

3. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63 suppl 86:8-160.

4. Lale AM, Mason JD, Jones NS. Mucociliary transport and its assessment: a review. Clin Otolaryngol Allied Sci. 1998;23(5):388-96.

5. Duchateau GS, Graamans K, Zuidema J, Merkus FW. Correlation between nasal ciliary beat frequency and mucus transport rate in volunteers. Laryngoscope. 1985;95 7 Pt 1:854-9.

6. Karja J, Nuutinen J, Karjalainen P. Radioisotopic method for measurement of nasal mucociliary activity. Arch Otolaryngol. 1982;108:99-101.

7. Andersen I, Camner P, Jensen PL, Philipson K, Proctor DF. Nasal clearance in monozygotic twins. Am Rev Respir Dis. 1974;110(3):301-5.

8. Button B, Okada SF, Frederick CB, Thelin WR, Boucher RC. Mechanosensitive ATP release maintains propermucus hydration of airways. Sci Signal. 2013;6(279), ra46.

9. Meltzer EO, Schatz M, Nathan R, Garris C, Stanford RH, Kosinski M. Reliability, validity, and responsiveness of the Rhinitis Control Assessment Test in patients with rhinitis. J Allergy Clin Immunol. 2013;131:379-86.

10. Bousquet PJ, Combescure C, Neukirch F, Klossek JM, Méchin H, Daures JP, et al. Visual analog scales can assess the severity of rhinitis graded according to ARIA guidelines. Allergy. 2007;62:367-72.

11. Houtmeyers E, Gosselink R, Gayan-Ramirez G, Decramer M. Regulation of mucociliary clearance in health and disease. Eur Respir J. 1999;13(5):1177-88.

12. Maurizi M, Paludetti G, Todisco T, Almadori G, Ottaviani F, Zappone C, et al. Ciliary ultrastructure and nasal mucociliary clearance in chronic allergic rhinitis. Rhinology. 1984;22(4):233-40.

13. Kirtsreesakul V, Somjareonwattana P, Ruttanaphol S. Impact of IgE-mediated hypersensitivity on nasal mucociliary clearance.
Arch Otolaryngol Head Neck Surg. 2010;136(8):801-6.

14. Schuhl JF. Nasal mucociliary clearance in perennial rhinitis. J Invest Allergy Clin Immunol. 1995;5:333-6.

15. Mahakit P, Pumhirun P. A preliminary study of nasal mucociliary clearance in smoker, sinusitis and allergic rhinitis patients. Asian Pac J Allergy Immunol. 1995;13(2):119-21.

16. Arnaoutakis D, Collins WO. Correlation of mucociliary clearance and symptomatology before and after adenoidectomy in children. Int J Pediatr Otorhinolaryngol. 2011;75(10):1318-21.

17. Yazıcı H. Nasal mucociliary clearance in adenoid hypertrophy and otitis media with effusion. Curr Allergy Asthma Rep. 2015;15(12):74.

18. Di Berardino F, Zanetti D, D’Amato G. Nasal rinsing with an atomized spray improves mucociliary clearance and clinical symptoms during peak grass pollen season. Am J Rhinol Allergy. 2017;31(1):40-3.

19. Satdhabudha A, Poachanukoon O. Efficacy of buffered hypertonic saline nasal irrigation in children with symptomatic allergic rhinitis: a randomized double-blind study. Int J Pediatr Otorhinolaryngol. 2012;76(4):583-8.

20. Elwany S, Ibrahim AA, Mandour Z, Talaat I. Effect of passive smoking on the ultrastructure of the nasal mucosa in children. Laryngoscope. 2012;122(5):965-9.

21. Habesoglu TE, Kule M, Kule ZG, Deveci HS, Yaylaci A, Gursel AO, et al. How does parental smoking affect nasal mucociliary clearance in children? Eur Arch Otorhinolaryngol. 2015;272(3):607-11.

22. Proctor DF, Wagner HN. Clearance of particles from the human nose. Arch Environ Health. 1965;11:366-71.