Carotid Doppler ultrasound measurements in allergic rhinitis patients

Abstract

Aim: We aimed to determine with carotid Doppler ultrasound (CDU) whether the increase in inflammatory cells and mediators plays a role in intima-media thickening in patients with allergic rhinitis (AR) and to correlate this with the severity of the disease. Material and Method: In this retrospective study, CDU reports and images of allergic rhinitis patients were evaluated in Group 1 (n=16). Score for allergic rhinitis (SFAR) and blood parameters that Hemoglobin (Hb), White Blood Cells (WBC), C-Reactive Protein (CRP), sedimentation levels were noted. Control group without AR consisted of 17 patients. In both groups, the presence of plaque on common carotid artery (CCA), and internal carotid artery (ICA) and all intima-media thickness were noted by CDU. Results: In our study, CCA intima-media thickness and ICA intima-media thickness values of the AR group were significantly higher than those in the control group bilaterally (p<0.05). In the AR group, there were positive correlations between CCA intima-media thickness and ICA intima-media thickness values (p<0.05). In the AR and control groups, there were no plaques in ICAs bilaterally. However, left CCA plaques were detected in 2 patients (12.5%) of the AR group. In the AR group, CCA and ICA intima-media thicknesses increased in older patients; and right ICA intima-media thickness values increased in males (p<0.05). Conclusion: Allergic rhinitis is one of the most common inflammatory diseases. It is known that the increase in mediators and inflammatory cells in the body can cause atherosclerosis. It should be kept in mind that AR patients may develop early atherosclerosis and therefore an increased cardiovascular risk.

Keywords

• Allergic rhinitis
• CCA intima-media thickness
• ICA intima-media thickness
• plaque.

References

1. Dykewicz MS, Fineman S. ExecutiveSummary of JointTask Force Practice Parameters on Diagnosis and Management of Rhinitis. Ann Allergy Asthma Immunol 1998; 81: 463–68.
2. Bernstein JA, Allergic and mixed rhinitis: Epidemiology and natural history. Allergy Asthma Proc 2010; 31: 365–9.
3. Nathan RA. The burden of allergic rhinitis. Allergy Asthma Proc 2007; 28: 3–9.
4. Randhawa P, Mansuri S, Rubin J. Is dysphonia due to allergic laryngitis being misdiagnosed as laryngopharyngeal reflux? Logopedics Phoniatrics Vocol 2009; 35: 1–5.
5. Zhu Y, Xian X, Wang Z, et al. Research Progress on the Relationship between Atherosclerosis and Inflammation. Biomolecules 2018;23; 8: 80.
6. Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis. Nature 2011; 473: 317–25.
7. Lee W. General principles of carotid Doppler ultrasonography. Ultrasonography 2014; 33: 11-7.
8. Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 1997; 2; 96: 1432-7.

9. Cingi C, Muluk NB, Susaman N, et al. The Score for Allergic Rhinitis study in Turkey, 2020. ENT-Updates 2021; 11: 1-7.
10. Annesi-Maesano I, Didier A, Klossek M, Chanal I, Moreau D, Bousquet J. The score for allergic rhinitis (SFAR): a simple and valid assessment method in population studies. Allergy 2002; 57: 107-14.
11. Cingi C, Songu M, Ural A, et al. The Score For Allergic Rhinitis study in Turkey. Am J Rhinol Allergy 2011; 25: 333-7.
12. Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986; 74: 1399–406.
13. Wang XD, Zheng M, Lou HF, et al. An increased prevalence of self reported allergic rhinitis in major Chinese cities from 2005 to 2011. Allergy 2016; 71: 1170-80.
14. Leth-Møller KB, Skaaby T, Linneberg A. Allergic rhinitis and allergic sensitisation are stil increasing among Danish adults. Allergy 2020; 75: 660-68.
15. Galli SJ, Tsai M, Piliponsky AM. The development of allergic inflammation. Nature 2008; 454: 445-54.
16. Meng Y, Wang C, Zhang L. Recent developments and highlights in allergic rhinitis. Allergy 2019; 74: 2320-28.
17. Kalyoncu AF, Demir AU, Ozcakar B et al. Asthma and allergy in Turkish university students: Two cross-sectional surveys 5 years apart. Allergol Immunopathol (Madr) 29: 264–271, 2001.
18. Knoflach M, Kiechl S, Mayr A, Willeit J, Poewe W, Wick G. Allergic rhinitis, asthma, and atherosclerosis in the Bruneck and ARMY studies. Arch Intern Med 2005 28; 165: 2521-6.
19. Wick G, Knoflach M, Xu Q. Autoimmune and inflammatory mechanisms in atherosclerosis. Annu Rev Immunol 2004; 22: 362-403.
20. Togias A. Systemic effects of local allergic disease. J Allergy Clin Immunol 2004; 113: S8-14.
21. Kiechl S, Egger G, Mayr M, et al. Chronic infections and the risk of carotid atherosclerosis: prospective results from a large population study. Circulation 2001; 103: 1064-70.
22. Grobbee DE, Bots ML: Carotid artery intima-media thickness as an indicator of generalized atherosclerosis. J Intern Med 1994; 236: 567-73.
23. Cao JJ, Arnold AM, Manolio TA, et al. Association of carotid artery intima media thickness, plaques, and C-reactive protein with future cardiovascular disease and all-cause mortality: The Cardiovascular Health Study. Circulation 2007; 116: 32-38.
24. Rosvall M, Janzon L, Berglund G, Engström G, Hedblad B. Incidence of stroke is related to carotid IMT even in the absence of plaque. Atherosclerosis 2005; 179: 325-31.