Nasal nitric oxide and its metabolites as potential biomarkers for the diagnosis and follow-up of allergic rhinitis

Year 2017, Volume: 7 Issue: 3, 113 - 119, 28.08.2017

Zerrin Özergin Coşkun Selçuk Arslan Orhan Değer Mehmet İmamoğlu

https://izlik.org/JA25KT35XH

Abstract

Objective: This study was conducted to
investigate nasal nitric oxide (nNO) and its metabolites nasal
nitrite-nitrate (nNOx) in patients with allergic rhinitis (AR), the
effects of two different drugs (oral antihistamine and intranasal
steroid) on nNOx and the presence of a correlation between nNOx and
clinical parameters.




Methods: Sixty
patients with active symptoms of perennial AR and 25 healthy adults as a
control group were enrolled. The patients were randomized into two
groups. Half of the patients received fexofenadine 1x120 mg/day orally,
and the other half received triamcinolone acetonide 1x2 puff/day
intranasally for one month. The amount of nNOx in nasal lavage fluid was
measured by using a commercially available kit and the photometric
endpoint determination method.




Results:
Pre-treatment levels of NOx in the nasal lavage fluids (1.92± 1.20 mg/l)
of patients with AR were found to be significantly higher when compared
with nasal lavage fluid NOx levels of healthy adults (1.38±0.78 mg/l)
(p=0.04). The post-treatment nNOx level (1.52±0.85 mg/l) was
significantly lower when compared with the pre-treatment value
(p=0.028).




Conclusion:
Nasal nitric oxide metabolites were shown to be good biomarkers for AR,
and that oral fexofenadine significantly decreased nNOx levels.

Keywords

Allergic rhinitis , nitric oxide , nitrite , nitrate , nasal lavage , fexofenadine , triamcinolone acetonide , nasal steroid , antihistaminic

References

• 1. Wallace DV, Dykewicz MS, Bernsteinet DI, et al.; Joint Task Force on Practice; American Academy of Allergy; Asthma & Immunology; American College of Allergy; Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol 2008;122(Suppl 2):1–84. 2. Ignarro LJ, Buga GM, Wood KS, Byrns RE, Chaudhuri G. Endothelium-derived relaxing factor produced and released from artery and vein is nitric oxide. Proc Natl Acad Sci U S A 1987;84:9265–9. 3. Radomski MW, Palmer RM, Moncada S. The role of nitric oxide and cGMP in platelet adhesion to vascular endothelium. Biochem Biophys Res Commun 1987;148:1482–9. 4. Nijkamp FB, Folkerts G. Nitric oxide: initiator and modulator. Clin Exp Allergy1997;27:347–50. 5. Bülbül T, Bülbül OG, Güçlü O, Bilsel AS, Gürsan SÖ. Effect of glucocorticoids on nasal polyposis, with detection of inflammatory response by measurement of nitric oxide levels in nasal polyp tis- sue. J Laryngol Otol 2013;127:584–9. 6. Altundag A, Salihoglu M, Cayonu M, Cingi C, Tekeli H, Hummel T. The effect of high altitude on nasal nitric oxide levels. Eur Arch Otorhinolaryngol 2014;271:2583–6. 7. Imoto Y, Yamada T, Tsukahara H, et al. Nitrite/nitrate in nasal lavage fluid reflects nasal symptoms after a single nasal allergen provocation in patients with seasonal allergic rhinitis. J Investig Allergol Clin Immunol 2015;25:382–4. 8. Liu D, Huang Z, Huang Y, Yi X, Chen X. Measurement of nasal and fractional exhaled nitric oxide in children with upper airway inflammatory disease: preliminary results. Int J Pediatr Otorhinolaryngol 2015;79:2308–11. 9. Krantz C, Janson C, Borres MP, Nordvall L, Alving K, Malinovschi A. Nasal nitric oxide is associated with exhaled NO, bronchial responsiveness and poor asthma control. J Breath Res 2014;8:026002. 10. Can D, Tanaç R, Demir E, Gülen F, Veral A. Efficacy of pollen immunotherapy in seasonal allergic rhinitis. Pediatr Int vol 2007;49:64–9. 11. Fokkens W, Lund V, Mullol J; European Position Paper on Rhinosinusitis and Nasal Polyps Group. EP3OS: European posi- tion paper on rhinosinusitis and nasal polyps 2007. A summary for otorhinolaryngologists. Rhinology 2007;45:97–101. 12. Bousquet J, Heinzerling L, Bachert C, et al.; Allergy and Asthma European Network; Allergic Rhinitis and its Impact on Asthma. Practical guide to skin prick tests in allergy to aeroallergens. Allergy 2012;67:18–24. 13. Naclerio RM, Meier HL, Kagey-Sobotka A, et al. Mediator release after nasal airway challenge with allergen. Am Rev Respir Dis 1983;128:597–602. 14. Howarth PH, Persson CG, Meltzer EO, Jacobson MR, Durham SR, Silkoff PE. Objective monitoring of nasal airway inflammation in rhinitis J Allergy Clin Immunol 2005;115:414–41. 15. Irander K, Borres MP, Palm JP. Acoustic rhinometry, spirometry and nitric oxide in relation to airway allergy and smoking habits in an adolescent cohort. Int J Pediatr Otorhinolaryngol, 2011;75:177–81. 16. Serrano C, Valero A, Picado C. Nasal nitric oxide. [Article in Spanish] Arch Bronconeumol 2004;40:222–30. 17. Lanz MJ, Prendes S, Peyrou N, Toledo G, Ferrer CM. Nasal nitric oxide as a noninvasive marker in the antibiotic treatment of acute bacterial sinusitis. J Allergy Clin Immunol 2008;121:530–1. 18. Kang SH, Dalcin Pde T, Piltcher OB, Migliavacca Rde O. Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment. J Bras Pneumol 2015;41:65–76. 19. Coskun ZO, Erdivanli OC, Gumus A, et al. Rates of new asthma diagnosis in patients with allergic rhinitis in otorhinolaryngology practice in the Eastern Black Sea region. Medical Science and Technology 2016;57:16-20. 20. Ciprandi G, Tosca MA, Capasso M. Exhaled nitric oxide in chil- dren with allergic rhinitis and/or asthma: a relationship with bronchial hyperreactivity. J Asthma 2010;47:1142–7. 21. Suojalehto H, Vehmas T, Lindström I, et al. Nasal nitric oxide is dependent on sinus obstruction in allergic rhinitis. Laryngoscope 2014;124:E213–8. 22. Gupta N, Goel N, Kumar R. Correlation of exhaled nitric oxide, nasal nitric oxide and atopic status: a cross sectional study in bronchial asthma and allergic rhinitis. Lung India 2014;31:342–7. 23. Sahin G, Klimek L, Mullol J, Hörmann K, Walther LE, Pfaar O. Nitric oxide: a promising methodological approach in airway dis- eases. Int Arch Allergy Immunol 2011;156:352–61. 24. Baflc›o¤lu A, Yorganc›o¤lu A, Cingi C, Çuhadaro¤lu Ç. Role of leukotriene antagonists and antihistamines in treatment of allergic rhinitis and asthma comorbidity. J Med Updates 2013;3:34–9. 25. Kalpaklioglu AF, Kavut AB. Comparison of azelastine versus tri- amcinolone nasal spray in allergic and nonallergic rhinitis. Am J Rhinol Allergy 2010;24:29–33. 26. Bautista AP, Eisenlohr CP, Lanz MJ. Nasal nitric oxide and nasal eosinophils decrease with levocetirizine in subjects with perennial allergic rhinitis Am J Rhinol Allergy 2011;25:383–7. 27. Asano K, Kanai K, Furuta A, Furuya A, Suzaki H, Hisamitsu T. Suppressive activity of fexofenadine hydrochloride on nitric oxide production in-vitro and in-vivo. J Pharm Pharmacol 2007;59:1389– 95. 8. Takeno S, Osada R, Furukido K, Chen JH, Yajin K. Increased nitric oxide production in nasal epithelial cells from allergic patients – RT-PCR analysis and direct imaging by a fluorescence indicator: DAF-2 DA. Clin Exp Allergy 2001;31:881–8. 29. Kawamato H, Takumida M, Takeno S, Watanabe H, Fukushima N, Yajin K. Localization of nitric oxide synthase in human nasal mucosa with nasal allergy. Acta Otolaryngol Suppl 1998;593:65– 70. 30. Dweik RA, Boggs PB, Erzurum SC, et al.; American Thoracic Society Committee on Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med 2011;184:602–15. 31. Bjermer L, Alving K, Diamant Z, et al. Current evidence and future research needs for FeNO measurement in respiratory diseases. Respir Med 2014;108:830–41.