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A Pilot Study Investigating Clinical Responses and Biological Pathways of Azelastine/Fluticasone in Nonallergic Vasomotor Rhinitis before and after Cold Dry Air Provocation.

Abstract Nonallergic vasomotor rhinitis (NAVMR) has been considered a diagnosis by exclusion due to unknown mechanisms or lack of diagnostic biomarkers.
PMID
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Authors

Mayor MeshTerms
Keywords

Antihistamines

Azelastine

Cold stimulation

Environmental exposure chamber

Fluticasone

MicroRNA

Nasal lavage

Nasal mucosa

Nonallergic vasomotor rhinitis

Substance P

Journal Title international archives of allergy and immunology
Publication Year Start




PMID- 28787742
OWN - NLM
STAT- Publisher
DA  - 20170808
LR  - 20170808
IS  - 1423-0097 (Electronic)
IS  - 1018-2438 (Linking)
VI  - 173
IP  - 3
DP  - 2017 Aug 09
TI  - A Pilot Study Investigating Clinical Responses and Biological Pathways of
      Azelastine/Fluticasone in Nonallergic Vasomotor Rhinitis before and after Cold
      Dry Air Provocation.
PG  - 153-164
LID - 10.1159/000478698 [doi]
AB  - BACKGROUND: Nonallergic vasomotor rhinitis (NAVMR) has been considered a
      diagnosis by exclusion due to unknown mechanisms or lack of diagnostic
      biomarkers. METHODS: To determine clinical responses and biological pathways in
      NAVMR subjects challenged to cold dry air (CDA) in an environmental exposure
      chamber (EEC) pre- and posttreatment with azelastine/fluticasone (AzeFlu), 30
      NAVMR subjects, prescreened for CDA-induced symptoms (approx. 14 degrees C, <15% 
      relative humidity, x1 h) were randomized to treatment with AzeFlu (n = 20) or
      placebo (n = 10) for 2 weeks. Total nasal symptoms scores, minimum
      cross-sectional area, cough, and conjunctival redness were recorded at visit 1
      (pretreatment) and visit 2 (posttreatment) before, during, and after CDA
      challenge. At both visits, nasal lavage fluid (NLF) and nasal scrapings (NS) were
      collected pre- and post-CDA challenge. Substance P, neurokinin-A, and calcitonin 
      gene-related peptide concentrations in NLF were analyzed pre- and postchallenge
      at each visit. Their relationship with CDA-induced symptoms was determined by
      statistical analysis. MicroRNA sequencing from NS determined differentially
      expressed miRNA between the treatment groups post-CDA challenge at each visit.
      RESULTS: The minimum cross-sectional area (p < 0.05), cough count (p < 0.05), and
      substance P (p < 0.01) improved posttreatment with AzeFlu versus placebo. Gene
      targets for differentially expressed miRNAs at visit 1 were enriched for
      biological pathways regulating epithelial ciliogenesis and cell integrity that
      were modified in the AzeFlu-treated group versus placebo posttreatment.
      CONCLUSIONS: This study demonstrated the feasibility of an EEC model to
      investigate CDA-induced clinical responses and pathobiology in NAVMR subjects
      pre- and posttreatment with AzeFlu. NAVMR disease mechanisms for other
      nonallergic triggers can be investigated similarly.
CI  - (c) 2017 S. Karger AG, Basel.
FAU - Singh, Umesh
AU  - Singh U
AD  - University of Cincinnati Medical Center, Cincinnati, OH, USA.
FAU - Bernstein, Jonathan A
AU  - Bernstein JA
FAU - Lorentz, Holly
AU  - Lorentz H
FAU - Sadoway, Tara
AU  - Sadoway T
FAU - Nelson, Victoria
AU  - Nelson V
FAU - Patel, Piyush
AU  - Patel P
FAU - Salapatek, Anne Marie
AU  - Salapatek AM
LA  - eng
PT  - Journal Article
DEP - 20170809
PL  - Switzerland
TA  - Int Arch Allergy Immunol
JT  - International archives of allergy and immunology
JID - 9211652
OTO - NOTNLM
OT  - Antihistamines
OT  - Azelastine
OT  - Cold stimulation
OT  - Environmental exposure chamber
OT  - Fluticasone
OT  - MicroRNA
OT  - Nasal lavage
OT  - Nasal mucosa
OT  - Nonallergic vasomotor rhinitis
OT  - Substance P
EDAT- 2017/08/09 06:00
MHDA- 2017/08/09 06:00
CRDT- 2017/08/09 06:00
PHST- 2016/12/05 [received]
PHST- 2017/06/13 [accepted]
AID - 000478698 [pii]
AID - 10.1159/000478698 [doi]
PST - aheadofprint
SO  - Int Arch Allergy Immunol. 2017 Aug 9;173(3):153-164. doi: 10.1159/000478698.