Nasal hyperreactivity after short-time cold dry air provocation in chronic rhinitis patients.

Chronic rhinitis is a common disorder, that can have a great impact on quality
of life of patients.
The pathofysiology of chronic rhinitis is not completely understood. Especially
the role and definition of nasal hyperreactivity in the different types of
chronic rhinitis patients stays unclear. Hypotheses state that nasal
hyperreactivity could be a neurologic disorder or a disbalance of the sympathic
and parasympathic neurologic systems, a symptom with an inflammatoiry
background or even a hidden local allergy of the nasal mucosa.
For a long time nasal hyperreactivity was mainly correlated with non-allergic
rhinitis patients, but recent evidence shows that also allergic rhinitis
patients can have symptoms of nasal hyperreactivity, apart from their IgE
mediated allergy symptoms.

The clinical response will be measured in allergic and non-allergic rhinitis
patients and healthy participants. This will be done by means of symptom
scores: visual analogue score (VAS) and rhinitis symptome score (RSS) and by
means of measuring nasal patency and flow: peak nasal inspiratory flowmetry
(PNIF).

Three groups of 30 participants, ie. 30 allergic rhinitis patients, 30
non-allergic rhinitis patients and 30 healthy controles will be included.
Participants will be recruted from previous studies of the ENT AMC Research
Departments (like the NAR study), but also from the population of (chronic)
rhinitis patients visiting the ENT outpatient clinic or the ENT research
department during the previous years and who all received a documented allergy
test (skin prick test).
To be included in our study allergy will be (again) investigated by means of a
skin prick test according to GA2LEN standards with the 18 most common
inhalation allergens. In non-allergic rhinitis patients and healthy controls
results of skin prick testing have to be completely negative apart from the
positive control. In allergic rhinitis patients apart from the positive control
at least one other positive result has to come up.
Chronic rhinitis patients have to have for at least 1 year symptoms of the
nose, ie at least one of the following symptoms: rhinorrhoea (runny nose),
nasal congestion (blocked nose), itchy nose, sneezing or burning/painful
sensation in the nose. These symptoms have to be at least troublesome for the
patient.
Patients have to stop local (or systemic) corticosteroids 4 weeks before their
visit, and antihistamines (spray or tablet) 3 days before their visit.
The visit will include a screening and allergy investigation (skin prick test).
(60 minutes) During this screening visit demographic features and symptoms of
rhinitis, medicale history and medication use -as applicable- will be
documented and an ENT and a short general physical examination will be
performed.
Than provocation with cold dry air will take place. (20 minutes) One minute
before provocation patients will fill in a Visual Analogue Scale (VAS) for 5
different nasal symptoms. (rhinorrhoea, nasal congestion, itchy nose, sneezing,
burning/pain) and a Rhinitis Symptom Score (RSS) for the same 5 symptoms. Also
a Peak Nasal Inspiratoiry Flow Measurement (PNIF) will be performed to assess
nasal patency.
After this screening part a provocation of 15 minutes breathing of cold dry air
of at least minus 10 degrees Celcius with a flow of 25 L/minute through the
nose with a nasal silicon mask will take place, as described by Braat etal in
1997. At one minute after ending 15 minutes provocation, patients will again
fill in the VAS scores and RSS scores and perform another Peak Nasal
Inspiratory Flow Measurement (PNIF).
After these measurements the visit will be ended.

All groups will undergo a nasal provocation with dry cold air for 15 minutes.

Patients with rhinitis stop the use of their nasal medication within one month
before participation. Antihistamines will not be taken 48 hour before the
visit. There is a chance of a considerable increase of their rhinitis symptoms.
If abstinence from their medication is not possible, subjects cannot be
included in this study.
All participants visite the ENT- Research Department during two hours, in
which skinprick test, screening and nasal provocation will be performed.