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INTRODUCTION
The human nose is an
important and complex organ with many functions, including ventilation,
filtration and olfaction. People who suffer from nasal function impairment have
a reduced overall quality of life. Nasal Obstruction (NO) is defined as the
subjective perception of discomfort or difficulty in the passage of air through
the nostrils, and it is thought that this sensation is physiologically or
pathologically generated in the trigeminal sensory receptors of the nasal
mucosa. The terms obstruction and nasal congestion may be used as synonyms,
although obstruction usually refers to the subjective sensation of irreversible
blockage. Nasal Obstruction (NO) is a symptom that is frequently reported by
patients in primary care and otorhinolaryngology and allergy consultations
[1-4]. Although there are no precise data, it is estimated that the condition
may affect at least 30%-40% of the general population [1,2].
NO is an annoying symptom that greatly
affects Quality of Life (QOL), predisposes to and exacerbates lower airway
diseases, alters night-time rest, decreases work efficiency, and aggravates
sleep apnea [1,4,5]. Diagnosis of its specific cause is essential to be able to
select the appropriate therapy. The enormous social and health care expenditure
that it entails results from factors such as incorrect diagnoses and/or
unsuitable treatment [1,5,6].
NO is frequently reported by patients in
primary care and in specialized care. It has a huge impact on patients’ QOL and
especially on sleep quality. As it can be caused by various factors, a complete
medical history and clinical examination are the main basis of etiological
diagnosis. Furthermore, although both the pattern and location can suggest the
underlying disease, objective and subjective assessment tools are useful for
evaluation of NO [1-3].
The
pathophysiology of Allergic rhinitis is a complex inflammation with numerous
cytokines and inflammatory mediators, although Allergic rhinitis symptoms are
recurrent and the airway inflammation in Allergic rhinitis is persistent. The
airway inflammation pattern appears to be similar in all clinical forms of
asthma and in all age groups, including allergic, non-allergic or
aspirin-induced. Mast cells, eosinophils, T lymphocytes, dendritic cells (DCs),
macrophages and neutrophils are the primary cells involved in the inflammatory
processes. Immunoglobulin E (IgE) plays a central role in the pathophysiology
of asthma, as in other allergic diseases, such as urticaria, food allergy and
allergic rhinitis [7-10]. In the early allergic phase, the allergen is first
taken up by the DCs in the body and processed to present to antigen-specific
T-cells. During this process, T lymphocytes transforming into Th 2 phenotype
provide the development of IgE-producing B cells. The crystallized Fc portion
of the free IgE binds to the high-affinity IgE receptor (FcεRI) on the
basophils and mast cells. Mast cells with IgE bound to the FcεRI receptors on
the surface are activated through allergen exposure [8-10].
The efficacy of
humanized anti-IgE monoclonal antibody (omalizumab) was first evaluated in a
randomized, double-blind, placebo-controlled study of 221 patients with seasonal
allergic rhinoconjunctivitis [11]. That
study showed that
In 2007, a
randomized placebo-controlled study of eight patients was the first to report
reduced rates of postoperative polyp recurrence in patients with atopic asthma and
nasal polyps (NP) [13]. In a study of 19 patients with severe asthma and NP in
2011, Vennera et al. [14] reported symptom reduction and disease stabilization
with the use of omalizumab treatment. In addition, Tajiri et al. [15] evaluated
omalizumab in patients with severe asthma and NP and reported significant
improvements in nasal symptoms, asthma control, and sinus tomography results.
However, not all studies have been able to show the beneficial effects of the
treatment. In a randomized, double-blind, placebo-controlled study of patients
with chronic rhinosinusitis receiving omalizumab, Pinto et al. [16] showed
improvement in the Sino-Nasal Outcome Test (SNOT-20) scores at 3, 5 and 6
months, although there was no significant difference in the scores compared to
the control group.
The human nose is a complex organ that shows
large morphological variations and has many important functions. However, the
relationship between shape and function is not yet fully understood. In a
previous study, a high quality statistical shape model of the human nose was
presented based on clinical CT data of 46 patients. A technique based on
cylindrical parametrization was used to create a correspondence between the
nasal shapes of the population. Applying principal component analysis to these
corresponding nasal cavities resulted in highly accurate average nasal geometry
and geometrical variations, known as principal components, present in the
population. The analysis resulted in 46 principal components, accounting for
95% of the total geometric variation captured. These variations are first
discussed qualitatively, and the effect on the average nasal shape of the first
five principal components is visualized. Hereafter, by using this statistical
shape model, two application examples that lead to quantitative data are shown:
nasal shape in function of age and gender, and a morphometric analysis of
different anatomical regions. Shape models, such as the one presented here, can
help in the better understanding of nasal shape and variation and their
relationship with demographic data [17]. These findings suggest that humanised
monoclonal antibody treatments (OMALIZUMAB) could show an effect on nasal
mucosa because of the anti-inflammatory effects at the mast cell level.
Previous
studies have suggested that omalizumab is a novel and promising agent for the
long-term control of allergic asthma [7-10,18-22] and have also documented the
clinical effect of Th1/2 cytokines, pro-inflammatory proteins (CD200), IL-22,
IL-10RB, IL-25 and IL-33 signaling in the pathogenesis of SPA [18-22].
Omalizumab treatment has been observed to not only improve asthma symptoms but
also allergic rhinoconjunctivitis symptoms, thereby improving quality of life
for patients and nasal and pulmonary airflow.
CONCLUSION
In conclusion,
Omalizumab treatment may play a role in the regulation of nasal airflow,
reducing the need for topical steroids. However, large-scale, prospective,
randomized clinical studies are needed to establish a definite conclusion.
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