PITTSBURGHA paucity of information exists on air quality and rhinitis in the pathophysiology of upper airway disease, according to a new study assessing the effect of inhalant pollutants (particulate matter 2.5 [PM2.5] and black carbon [BC]) on allergic rhinitis and chronic rhinosinusitis (CRS) disease severity.

For the study in the journal International Forum of Allergy & Rhinology, CRS patients with nasal polyps (CRSwNP) and without polyps (CRSsNP) were identified. Spatial modeling from pollutant monitoring sites was used to estimate exposures for patients meeting the inclusion criteria Overall, 125 patients were included, divided between those with and without nasal polyps.1

Researchers from the University of Pittsburgh and the San Antonio Military Medical Center employed skin-prick, intradermal dilutional and in-vitro testing methods to determine aeroallergen sensitization. Modified Lund-Mackay score (LMS), the 22-item Sino-Nasal Outcome Test (SNOT-22), systemic steroid therapy and number of functional endoscopic sinus surgeries (FESS) were used to measure disease severity indicators.

Results indicated that 36% of patients who described rhinitis symptoms demonstrated no reactivity to aeroallergen testing, while 64% tested positive for at least one allergen, with no differences found between CRSsNP and CRSwNP62.1% vs 67.2%). Significant differences in air pollutants between patients testing negative and positive for allergies (nonallergic vs. allergic: PM2.5, 11.32 vs. 11.07 μg/m3, p = 0.030; BC, 0.81 vs. 0.76 absorbance, p =0.044) were documented.

Researchers pointed out that nonallergic CRSwNP demonstrated higher PM2.5 compared with allergic counterparts (11.48 vs. 11.09 μg/m3, p = 0.032), and that a similar pattern was observed with BC (0.82 vs. 0.75 absorbance, p = 0.017). In CRSsNP, BC correlated significantly with SNOT-22 (r = 0.55, p = 0.042).

“Our results suggest that small inhalant pollutants may contribute to nonallergic symptomatology in patients with and without nasal polyps,” the study authors concluded. “Regardless of allergy status, BC may play a role in CRS symptom severity.”

Mady LJ, Schwarzbach HL, Moore JA, Boudreau RM, Kaffenberger TM, Willson TJ, Lee SE. The association of air pollutants and allergic and nonallergic rhinitis in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2017 Dec 11. doi: 10.1002/alr.22060. [Epub ahead of print] PubMed PMID: 29227043.