Inflammation, infection, and allergy of upper airways: new insights from national and real-world studies

Attilio Varricchio, Ignazio La Mantia, Francesco Paolo Brunese, Giorgio Ciprandi, Attilio Varricchio, Ignazio La Mantia, Francesco Paolo Brunese, Giorgio Ciprandi

Abstract

The upper airways (UA) should be considered as a functional unit. Current functional anatomy divides URT in three, mutually dependent, "junction boxes": i) the ostio-meatal complex (OMC), ii) the spheno-ethmoidal recess (SER), and iii) the rhinopharynx (RP). Correct ventilation and effective mucociliary clearance of these sites significantly affect the healthy physiology of the entire respiratory system. The OMC, SER, and RP obstruction is the first pathogenic step in the inflammatory/infectious cascade of UA disorders. The inflammation of the respiratory mucosa is the main pathogenic factor for airway obstruction. Moreover, bacterial biofilm (a strategy modality of bacterial survival) is an important local cause of systemic antibiotic ineffectiveness, recurrent infections, and antibiotic resistance. Health microbiota guarantees UA wellness; on the contrary, dysbiosis promotes and worsens UA infections. Allergy, namely type 2 inflammation, is a common cause of UA obstruction such as promoting in turn infections. Fiberoptic endoscopy is a mandatory diagnostic tool in clinical practice. Nasal cytology, mainly concerning flow cytometry, allows defining rhinitis phenotypes so allowing a precision medicine approach. Several conventional therapeutic approaches are available, but efficacy and safety should be ever properly considered before the prescription. Also, complementary medicine plays a fruitful role in the management of UA diseases. National and real-world studies are reported and discussed as they may be useful in daily clinical practice.

Keywords: Allergy; Anatomy; Infection; Inflammation; Physiology; Therapy; Upper airways.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Pitt E, Gallegos D, Comans T, Cameron C, Thornton L. Exploring the influence of local food environments on food behaviours: a systematic review of qualitative literature. Public Health Nutr. 2017;20:2393–2405. doi: 10.1017/S1368980017001069.
    1. Brennan A, Akehurst R. Modelling in health economic evaluation. What is its place? What is its value? Pharmacoeconomics. 2000;17:445–459. doi: 10.2165/00019053-200017050-00004.
    1. Use of real-world evidence to support regulatory decision-making for medical devices. Guidance for industry and Food and Drug Administration staff document issued on August 31, 2017. Bethesda: US Food and Drug Administration, US Department of Health and Human Services Food and Drug Administration, Center for Devices and Radiological Health Center for Biologics Evaluation and Research; 2017.
    1. Sherman RE, Anderson SA, Dal Pan GJ, Gray GW, Gross T, Hunter NL, et al. Real-world evidence—what is it and what can it tell us? N Engl J Med. 2016;375:2293–2297. doi: 10.1056/NEJMsb1609216.
    1. Ciprandi G, Cirillo I. The lower airway pathology of rhinitis. J Allergy Clin Immunol. 2006;118:1105–1109. doi: 10.1016/j.jaci.2006.05.010.
    1. Ciprandi G, Caimmi D, Miraglia del Giudice M, La Rosa M, Salpietro C, Marseglia G, et al. Recent developments in united airways disease. Allergy Asthma Immunol Res. 2012;4:171–177. doi: 10.4168/aair.2012.4.4.171.
    1. Fahey T, Stocks M, Thomas T. Systematic review of the treatment of upper respiratory tract infection. Arch Dis Child. 1998;79:225–230. doi: 10.1136/adc.79.3.225.
    1. Wald ER, Guerra N, Byers C. Upper respiratory tract infections in young children: duration and frequency of complications. Pediatrics. 1991;87:129.
    1. Wigand ME. Endonasal sinus surgery with endoscopical control: from radical operation to rehabilitation of the mucosa. Endoscopy. 1978;10:255–260. doi: 10.1055/s-0028-1098304.
    1. Dykewicz MS. Rhinitis and sinusitis. J Allergy Clin Immunol. 2003;111:S520–S529. doi: 10.1067/mai.2003.82.
    1. Watkins DS, Lewis RH, Bascalin KA, et al. Expression and localization of the inducible isoform of nitric oxide synthase in nasal epithelium. Clin Exp Allergy. 1998;28:211–219. doi: 10.1046/j.1365-2222.1998.00215.x.
    1. Djiupesland PG, Chatkin JM, Qian W, et al. Nitric oxide in nasal airway: a new dimension in otorhinolaryngology. Am J Otolaryngol. 2001;22:19–32. doi: 10.1053/ajot.2001.20700.
    1. Brandzaeg P. Immunobarriers of the mucosa of the upper respiratory and digestive pathways. Acta Otolaryngol (Stockh) 1988;105:172–180. doi: 10.3109/00016488809119462.
    1. Stankiewicz J. Chronic sinusitis. In: Johnson JT, Yu VL, editors. Infectious diseases and antimicrobial therapy of the ears, nose and throat. Philadelphia: WB Saunders Co; 1997.
    1. Ciprandi G, Buscaglia S, Pesce G. Minimal persistent inflammation is present at mucosal level in patients with asymptomatic rhinitis and mite allergy. J Allergy Clin Immunol. 1995;96:971–979. doi: 10.1016/S0091-6749(95)70235-0.
    1. Wolcott RD, Ehrlich GD. Biofilms and Chronic Infections. JAMA. 2008;299:2682–2684. doi: 10.1001/jama.299.22.2682.
    1. Zuliani G, Carron M, Gurrola J, Coleman C, Haupert M, Berk R, et al. Identification of adenoid biofilms in chronic rhinosinusitis. Int J Pediatr Otorhinolaryngol. 2006;70:1613–1617. doi: 10.1016/j.ijporl.2006.05.002.
    1. Ivarsson M, Ebenfelt A, Lundberg C. Do the leukocytes in the surface secretion on the adenoid have an immunological function? Acta Otolaryngol (Stockh) 1997;117:872–878. doi: 10.3109/00016489709114218.
    1. de Martino M, Vierucci A, Appendino C. Children with recurrent respiratory infections. Immunol Ped. 1981;4:76–81.
    1. de Martino M, Ballotti S. The child with recurrent respiratory infections: normal or not? Ped Allergy Immunol. 2007;18(Suppl. 18):13–18. doi: 10.1111/j.1399-3038.2007.00625.x.
    1. Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M. Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics. 2002;110:7–15. doi: 10.1542/peds.110.1.7.
    1. Greenberg D, Bilenko N, Liss Z. The burden of acute otitis media on the patient and family. Eur J Pediatr. 2003;162:576–581. doi: 10.1007/s00431-003-1260-5.
    1. de Benedictis FM, Bush A. Recurrent lower respiratory tract infections in children. BMJ. 2018;362:k2698. doi: 10.1136/bmj.k2698.
    1. Karevold G, Kvestad E, Nafstad P, Kvaerner KJ. Respiratory infections in schoolchildren: co-morbidity and risk factors. Arch Dis Child. 2006;91:391–395. doi: 10.1136/adc.2005.083881.
    1. Thompson M, Vodicka TA, Blair PS, Buckley DI, Heneghan C, Hay ADTARGET Programme Team Duration of symptoms of respiratory tract infections in children: systematic review. BMJ. 2013;347:f7027. doi: 10.1136/bmj.f7027.
    1. Toivonen L, Karppinen S, Schuez-Havupalo L, Teros-Jaakkola T, Vuononvirta J, et al. Burden of recurrent respiratory tract infections in children: A prospective cohort study. Pediatr Infect Dis J. 2016;35:e362–e369. doi: 10.1097/INF.0000000000001304.
    1. Patria MF, Esposito S. Recurrent lower respiratory tract infections in children: a practical approach to diagnosis. Paediatric Respir Rev. 2013;14:53–60. doi: 10.1016/j.prrv.2011.11.001.
    1. Fahy JV. Type 2 inflammation in asthma – present in most, absent in many. Nat Rev Immunol. 2015;15:57–65. doi: 10.1038/nri3786.
    1. Ciprandi G, Tosca MA, Silvestri M, Ricciardolo FLM. Inflammatory biomarkers for asthma endotyping and personalized therapy. Exp Rev Clin Immunol. 2017;13:715–721. doi: 10.1080/1744666X.2017.1313117.
    1. Ciprandi G, Tosca MA, Fasce L. Allergic children have more numerous and severe respiratory infections than non-allergic children. Ped Allergy Immunol. 2006;17:389–391. doi: 10.1111/j.1399-3038.2006.00413.x.
    1. Cirillo I, Marseglia G, Klersy C, Ciprandi G. Allergic patients have more numerous and prolonged respiratory infections than nonallergic subjects. Allergy. 2007;62:1087–1090. doi: 10.1111/j.1398-9995.2007.01401.x.
    1. Ciprandi G, Sormani MP, Cirillo I, et al. Upper respiratory infections and SLIT: preliminary evidence. Ann Allergy. 2009;102:262–263. doi: 10.1016/S1081-1206(10)60095-6.
    1. Griffin MR, Walker FJ, Iwane MK, et al. New vaccine surveillance network study group: epidemiology of respiratory infections in young children: insights from the new vaccine surveillance network. Pediatr Infect Dis J. 2004;23:188–192. doi: 10.1097/01.inf.0000144660.53024.64.
    1. Li J, Song X, Yang T, et al. A Systematic Review of Antibiotic Prescription Associated with Upper Respiratory Tract Infections in China. Medicine (Baltimore) 2016;95:e3587. doi: 10.1097/MD.0000000000003587.
    1. Alexandrino AS, Santos R, Melo C, et al. Caregivers’ education vs rhinopharyngeal clearance in children with upper respiratory infections: impact on children's health outcomes. Eur J Pediatr. 2017;176:1375–1383. doi: 10.1007/s00431-017-3003-z.
    1. Regli A, Becke K, von Ungern-Sternberg BS. An update on the perioperative management of children with upper respiratory tract infections. Curr Opin Anaesthesiol. 2017;30:362–367. doi: 10.1097/ACO.0000000000000460.
    1. Nazzari E, Torretta S, Pignataro L, et al. Role of biofilm in children with recurrent upper respiratory tract infections. Eur J Clin Microbiol Infect Dis. 2015;34:421–429. doi: 10.1007/s10096-014-2261-1.
    1. Gisselson-Solen M. Acute otitis media in children – current treatment and prevention. Curr Infect Dis Rep. 2015;17:22. doi: 10.1007/s11908-015-0476-7.
    1. Marchisio P, Bellussi L, Di Mauro G, Doria M, Felisati G, Longhi R, et al. Acute otitis media: from diagnosis to prevention. Summary of the Italian guideline. Int J Ped Otorhinolaryng. 2010;74:1209–1216. doi: 10.1016/j.ijporl.2010.08.016.
    1. Heidemann CH, Lous J, Berg J, Christensen JJ, Hakonsen SJ, Jakobsen M, et al. Danish guidelines on management of otitis media in preschool children. Int J Ped Otorhinolaryng. 2016;87:154–163. doi: 10.1016/j.ijporl.2016.06.003.
    1. Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131:e964–e999. doi: 10.1542/peds.2012-3488.
    1. Siddiq S, Grainger J. The diagnosis and management of acute otitis media: American Academy of Pediatrics guidelines 2013. Arch Dis Child Educ Pract. 2015;100:193–197. doi: 10.1136/archdischild-2013-305550.
    1. Kitamura K, Iino Y, Kamide Y, Kudo F, Nakayama T, Suzuki K, et al. Clinical practice guidelines for the diagnosis and management of acute otitis media (AOM) in children in Japan–2013 update. Auris Nasus Larynx. 2015;42:99–106. doi: 10.1016/j.anl.2014.09.006.
    1. Rettig E, Tunkel DE. Contemporary concepts in management of acute otitis media in children. Otolaryngol North Am. 2014;47:651–672. doi: 10.1016/j.otc.2014.06.006.
    1. Tamir SO, Shemesh S, Oron Y, Marom T. Acute otitis media guidelines in selected developed and developing countries: uniformity and diversity. Arch Dis Child. 2016;0:1–8.
    1. Morris PS, Leach AJ. Antibiotics for persistent nasal discharge (rhinosinusitis) in children. Cochrane Database Syst Rev. 2008;2:CD001094.
    1. Molstad S, Erntell M, Hanberger I, Melander E, Norman C, Skoog G, et al. Sustained reduction of antibiotic use and low bacterial resistance: 10-year follow-up of the Swedish Strama programme. Lancet Infect Dis. 2008;8:125–132. doi: 10.1016/S1473-3099(08)70017-3.
    1. Barbieri E, Donà D, Cantarutti A, Lundin R, Scamarcia A, Corrao G, et al. Antibiotic prescriptions in acute otitis media and pharyngitis in Italian pediatric outpatients. It J Pediatrics. 2019;45:103. doi: 10.1186/s13052-019-0696-9.
    1. Marseglia GL, Caimmi D, Pagella F, et al. Adenoids during childhood: the facts. Int J Immunopathol Pharmacol. 2011;24(4 Suppl):1–5. doi: 10.1177/03946320110240S401.
    1. Marseglia G, Poddighe D, Caimmi D, Marseglia A, Caimmi S, Ciprandi G, et al. Role of adenoids and adenoiditis in children with allergy and otitis media. Curr Allergy Asthma Rep. 2009;9:460–464. doi: 10.1007/s11882-009-0068-4.
    1. Mansback AI, Brihave P, Casimir G, et al. Clinical aspects of chronic ENT inflammation in children. B ENT. 2012;8(Suppl 19):83–101.
    1. Casselbrant ML. What is wrong in chronic adenoiditis/tonsillitis: anatomical considerations. Int J Pediatr Otorhinolaryngol. 1999;49(Suppl 1):S133–S135. doi: 10.1016/S0165-5876(99)00147-0.
    1. Cj P, Hiller LN, Nistico L, et al. The role of biofilms in otolaryngologic infections. Curr Opin Otolaryngol Head Neck Surg. 2007;15:347–351. doi: 10.1097/MOO.0b013e3282b97327.
    1. Graham JM, Scadding GK, Bull PD. Pediatric ENT. Berlin-Heidelberg: Springer; 2008.
    1. Maron T, Marchisio P, Tamir SO, Torretta S, Gavriel H, Esposito S. Complementary and alternative medicine treatment options for otitis media. Medicine. 2016;95:e2695. doi: 10.1097/MD.0000000000002695.
    1. Gao Z, Kang Y, Yu J, Ren L. Human pharyngeal microbiome may play a protective role in respiratory tract infections. Genomics Proteomics Bioinformatics. 2014;12:144–150. doi: 10.1016/j.gpb.2014.06.001.
    1. Marchisio P, Santagati M, La Mantia I, Scillato M. Streptococcus salivarius 24SMB administered by nasal spray for the prevention of acute media otitis in otitis-prone children. Eur J Microbiol Infect Dis. 2015;34:2377–2383. doi: 10.1007/s10096-015-2491-x.
    1. Tan R, Spector S. Pediatric sinusitis. Curr Allergy Asthma Rep. 2007;7:21–426. doi: 10.1007/s11882-007-0064-5.
    1. Magit A. Pediatric rhinosinusitis. Otolaryngol Clin. 2014;47:733–746. doi: 10.1016/j.otc.2014.06.003.
    1. Wald ER, Applegate KE, Bordley C, American Academy of Pediatrics Clinical practice guidelines for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132:e262–e280. doi: 10.1542/peds.2013-1071.
    1. Cyr C, Racette R, Leduc C, Blais C. Do symptoms and initial clinical probability predict the radiological diagnosis of acute sinusitis in children? Paediatr Child Health. 2001;6:536–539. doi: 10.1093/pch/6.8.536.
    1. Ueda D, Yoto Y. The ten-day mark as a practical diagnostic approach for acute paranasal sinusitis in children. Pediatr Infect Dis J. 1996;15:576–579. doi: 10.1097/00006454-199607000-00003.
    1. Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on Rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;23:1–298.
    1. Rimmer J, Hellings P, Lund VJ, Alobid I, Beale T, Dassi C, et al. European position paper on diagnostic tools in rhinology. Rhinology. 2019;57(Suppl S28):1–41.
    1. Bhattacharyya N, Jones DT, Hill M, Shapiro NL. The diagnostic accuracy of computed tomography in pediatric chronic rhinosinusitis. Arch Otolaryngol Head Neck Surg. 2004;130:1029–1032. doi: 10.1001/archotol.130.9.1029.
    1. Ramadan HH. Pediatric sinusitis: update. J Otolaryngol. 2005;34:S14–S17.
    1. Peters AT, Spector S, Hsu J, et al. Joint task force on practice parameters, representing the American Academy of allergy, asthma and immunology, the American college of allergy, asthma and immunology, and the joint council of allergy, asthma and immunology. Diagnosis and management of rhinosinusitis: a practice parameter update. Ann Allergy Asthma Immunol. 2014;113:347–385. doi: 10.1016/j.anai.2014.07.025.
    1. Orlandi RR, Kingdom TT, Hwang PH, et al. International consensus statement on allergy and rhinology: Rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(Suppl 1):S22–209.
    1. Tarantino V, Savaia V, D’Agostino R, Silvestri M, Passali FM, Ciprandi G. Bacteriotherapy in children with recurrent upper respiratory tract infections. Eur Rev Med Pharmacol Sci. 2019;23:39–43.
    1. Ciprandi G, Aragona SE, Drago L, La Mantia I. The nutraceuticals: a new therapeutic strategy in the management of digestive and respiratory disorders. Acta Biomed. 2019;7-S:5–7.
    1. Kakli HA, Riley TD. Allergic rhinitis. Prim Care. 2016;43:465–475. doi: 10.1016/j.pop.2016.04.009.
    1. Hoyte FCL, Nelson HS. Recent advances in allergic rhinitis. F1000Res. 2018;23:7.
    1. Blaiss MS, Hammerby E, Robinson S, Kennedy-Martin T, Buchs S. The burden of allergic rhinitis and allergic rhinoconjunctivitis on adolescents: A literature review. Ann Allergy Asthma Immunol. 2018;121:43–52.e3. doi: 10.1016/j.anai.2018.03.028.
    1. Ellis AK, Tenn MW. Advances in rhinitis: Models and mechanisms. Ann Allergy Asthma Immunol. 2018;121:61–64. doi: 10.1016/j.anai.2017.10.008.
    1. Okubo K, Kurono Y, Ichimura K, Enomoto T, Okamoto Y, Kawauchi H, et al. Japanese guidelines for allergic rhinitis 2017. Allergol Int. 2017;66:205–219. doi: 10.1016/j.alit.2016.11.001.
    1. Johnston J, McLaren H, Mahadevan M, Douglas RG. Clinical characteristics of obstructive sleep apnea versus infectious adenotonsillar hyperplasia in children. Int J Pediatr Otorhinolaryngol. 2019;116:177–180. doi: 10.1016/j.ijporl.2018.11.004.
    1. Ekici NY, Görgülü O, Yucel G, Külahcı Ö, Arıkan OK, Durmaz C. Can the number of eosinophils in adenoid and tonsil tissue determine the allergy in children? Int J Pediatr Otorhinolaryngol. 2018;108:35–39. doi: 10.1016/j.ijporl.2018.02.008.
    1. Cho KS, Kim SH, Hong SL, Lee J, Mun SJ, Roh YE, Kim YM, Kim HY. Local Atopy in Childhood Adenotonsillar Hypertrophy. Am J Rhinol Allergy. 2018;32:160–166. doi: 10.1177/1945892418765003.
    1. Sih T, Mion O. Allergic rhinitis in the child and associated comorbidities. Pediatr Allergy Immunol. 2010;21:e107–e113. doi: 10.1111/j.1399-3038.2009.00933.x.
    1. Ameli F, Brocchetti F, Tosca MA, Signori A, Ciprandi G. Adenoidal hypertrophy and allergic rhinitis: is there an inverse relationship? Am J Rhinol Allergy. 2013;27:e5–10. doi: 10.2500/ajra.2013.27.3854.
    1. Caplin I, Haynes JT, Houser D. Significance of the pale, boggy nasal mucosa. J Indiana State Med Assoc. 1968;61:981–982.
    1. Motomura C, Odajima H, Yamada A, Taba N, Murakami Y, Nishima S. Pale nasal mucosa affects airflow limitations in upper and lower airways in asthmatic children. Asia Pac Allergy. 2016;6:220–225. doi: 10.5415/apallergy.2016.6.4.220.
    1. Ameli F, Brocchetti F, Tosca MA, Signori A, Ciprandi G. Nasal endoscopy in children with suspected allergic rhinitis. Laryngoscope. 2011;121:2055–2059. doi: 10.1002/lary.22156.
    1. Hamizan AW, Christensen JM, Ebenzer J, et al. Middle turbinate oedema as a diagnostic marker of inhalant allergy. Int Forum Allergy Rhinol. 2017;7:37–42. doi: 10.1002/alr.21835.
    1. La Mantia I, Andaloro C. Demographic and clinical features predictive of allergic versus non-allergic rhinitis in children aged 6-18 years: a single-Centre experience of 1535 patients. Int J Ped Otorhinolaryngol. 2017;98:103–109. doi: 10.1016/j.ijporl.2017.04.044.
    1. Cirillo I, Gallo F, Ciprandi G. Could routine spirometry suggest sensitization in the military medicine setting? J R Army Med Corps. 2018;164:58–60. doi: 10.1136/jramc-2017-000841.
    1. Cirillo I, Gallo F, Ciprandi G. Impaired spirometry may predict bronchial hyper-responsiveness. J Allergy Clin Immunol Pract. 2018;6:2127–2129. doi: 10.1016/j.jaip.2018.02.030.
    1. Ciprandi G, Silvestri M, Pistorio A. Defining a diagnostic marker: a pragmatic requirement. Int Forum Allergy Rhinol. 2017;7:632–633. doi: 10.1002/alr.21936.
    1. Wise SK, Lin SY, Toskala E, et al. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol. 2018;8:200.
    1. Annunziato F, Romagnani C, Romagnani S. The 3 major types of innate and adaptive cell-mediated effector immunity. J Allergy Clin Immunol. 2015;135:626–635. doi: 10.1016/j.jaci.2014.11.001.
    1. Ciprandi G, Pronzato C, Ricca V, Bagnasco M, Canonica GW. Evidence of intercellular adhesion molecule-1 expression on nasal epithelial cells in acute rhinoconjunctivitis caused by pollen exposure. J Allergy Clin Immunol. 1994;94:738–746. doi: 10.1016/0091-6749(94)90182-1.
    1. Ciprandi G, Pronzato C, Ricca V, Passadaqua G, Bagnasco M, Canonica GW. Allergen-specific challenge induces intracellular adhesion molecule-1 (ICAM-1 or CD54) on nasal epithelial cells in allergic subjects. Am J Respir Crit Care Med. 1994;150:1653–1659. doi: 10.1164/ajrccm.150.6.7524984.
    1. Ricca V, Landi M, Ferrero P, Bairo A, Tazzer C, Ciprandi G. Minimal persistent inflammation is present also in patients with seasonal allergic rhinitis. J Allergy Clin Immunol. 2000;105:54–57. doi: 10.1016/S0091-6749(00)90177-5.
    1. Brożek JL, Bousquet J, Agache I, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140:950–958. doi: 10.1016/j.jaci.2017.03.050.
    1. Ciprandi G. Treatment of nonallergic perennial rhinitis. Allergy. 2004;56(S76):16–23. doi: 10.1111/j.0108-1675.2004.00390.x.
    1. Meltzer EO, Jalowayski AA. Nasal cytology in clinical practice. Am J Rhinol. 1988;2:47–54. doi: 10.2500/105065888781693212.
    1. Ciprandi G, Silvestri M. Standardization of the nasal cytology in the work-up of allergic rhinitis. Ann All Asthma Immunol 2019 (in press).
    1. Horvath KM, Herbst M, Zhou H, Zhang H, Noah TL, Jaspers I. Nasal lavage natural killer cell function is suppressed in smokers after live attenuated influenza virus. Respir Res. 2011;12:102. doi: 10.1186/1465-9921-12-102.
    1. Beiersdorf N, Schien M, Hentschel J, Pfister W, Markert UR, Mainz JG. Soluble inflammation markers in nasal lavage from CF patients and healthy controls. J Cyst Fibros. 2013;12(3):249–257. doi: 10.1016/j.jcf.2012.08.015.
    1. Aurora R, Chatterjee D, Hentzleman J, Prasad G, Sindwani R, Sanford T. Contrasting the microbiomes from healthy volunteers and patients with chronic rhinosinusitis. JAMA Otolaryngol Head Neck Surg. 2013;139:1328–1338. doi: 10.1001/jamaoto.2013.5465.
    1. Oshansky CM, Gartland AJ, Wong SS, Jeevan T, Wang D, Roddam PL, et al. Mucosal immune responses predict clinical outcomes during influenza infection independently of age and viral load. Am J Respir Crit Care Med. 2014;189:449–462. doi: 10.1164/rccm.201309-1616OC.
    1. Meng Q, Liu X, Li P, He L, Xie J, Gao X, et al. The influence of house dust mite sublingual immunotherapy on the TSLP-OX40L signalling pathway in patients with allergic rhinitis. Int Forum Allergy Rhinol. 2016;6:862–870. doi: 10.1002/alr.21743.
    1. Lee KS, Yu J, Shim D, Choi H, Jang MY, Kim KR, et al. Local immune responses in children and adults with allergic and nonallergic rhinitis. PLoS One. 2016;11:e0156979. doi: 10.1371/journal.pone.0156979.
    1. Takahashi T, Kato A, Berdnikovs S, Stevens WW, Suh LA, Norton JE, et al. Microparticles in nasal lavage fluids in chronic rhinosinusitis: potential biomarkers for diagnosis of aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2017;140:720–729. doi: 10.1016/j.jaci.2017.01.022.
    1. Varricchio A, Tajana G, Tommasino C, Melillo E, Camerlingo S, Rosolino I, et al. Feasibility of the flow cytometry in the rhinologist’s clinic. Acta Otorhinolaryngol Ital. 2019. 10.14639/0392-100X-2216. Epub ahead of print.
    1. Gelardi M, Fiorella ML, Russo C, Fiorella R, Ciprandi G. Role of nasal cytology. Int J Immunopathol Pharm. 2010;23:45–49.
    1. Ciprandi G, Mora F, Cassano M, Gallina AM, Mora R. V.A.S. and nasal obstruction in persistent allergic rhinitis. Otolaryngol HNS. 2009;141:527–529. doi: 10.1016/j.otohns.2009.06.083.
    1. Ciprandi G, Tosca MA, Silvestri M. Measuring the perception of symptoms, drug use, and allergen immunotherapy efficacy using the visual analogue scale. Exp Review Clin Immunol. 2014;10:179–182. doi: 10.1586/1744666X.2014.872034.
    1. Karabulut B, Sahin-Onder S, Erkmen B, Cetemen A, Gergin O. Predictive fiberoptic endoscopic findings of the upper airway in children with allergic rhinitis. Int J Ped Otorhinolaryngol. 2019;124:143–146. doi: 10.1016/j.ijporl.2019.06.004.
    1. Bousquet J, Pfaar O, Togias A, Schunemann HJ, Ansotegui I, Papadopoulos NG, et al. 2019 ARIA Care pathways for allergen immunotherapy. Allery. 2019;74(11):2087–2102. doi: 10.1111/all.13805.
    1. Campbell H, Hotchkiss R, Bradshaw N, Porteous M. Integrated care pathways. BMJ. 1998;316(7125):133–137. doi: 10.1136/bmj.316.7125.133.
    1. Hujala A, Taskinen H, Rissanen S, Richardson E, van Ginneken E. How to support integration to promote care for people with multimorbidity in Europe? European observatory policy briefs. Copenhagen: European Observatory on Health Systems and Policies; 2017.
    1. Palmer K, Marengoni A, Forjaz MJ, et al. Multimorbidity care model: recommendations from the consensus meeting of the joint action on chronic diseases and promoting healthy ageing across the life cycle (JA-CHRODIS) Health Policy. 2018;122(1):4–11. doi: 10.1016/j.healthpol.2017.09.006.
    1. Ciprandi G, Varricchio A, Capasso M, Varricchio AM, De Lucia A, Ascione E, et al. Hypertonic saline solution in children with adenoidal hypertrophy: preliminary evidence. Eur J Inflamm. 2007;5:159–163. doi: 10.1177/1721727X0700500307.
    1. Varricchio A., Giuliano M., Capasso M., Del Gaizo D., Ascione E., De Lucia A., Avvisati F., Capuano F., De Rosa G., Di Mauro F., Ciprandi G. Salso-Sulphide Thermal Water in the Prevention of Recurrent Respiratory Infections in Children. International Journal of Immunopathology and Pharmacology. 2013;26(4):941–952. doi: 10.1177/039463201302600412.
    1. La Mantia I, Ciprandi G, Varricchio A, Cupido F, Andaloro C. Salso-bromo-iodine thermal water: a nonpharmacological alternative treatment for postnasal drip-related cough in children with upper respiratory tract infections. J Biol Reg. 2018;32(1 Suppl. 2):41–47.
    1. Varricchio A, Tricarico D, De Lucia A, Utili R, Tripodi MF, del Giudice M, et al. Inhaled tobramycin in children with acute bacterial rhinopharyngitis. Int J Immunopathol Pharmacol. 2006;19:131–140. doi: 10.1177/205873920601900113.
    1. Varricchio A, Capasso M, Di Gioacchino M, Ciprandi G. Inhaled thiamphenicol and acetylcysteine in children with acute bacterial rhinopharyngitis. Int J Immunopathol Pharm. 2008;21:625–630. doi: 10.1177/039463200802100316.
    1. Ciprandi G, Tosca MA. Long-term cetirizine treatment reduces allergic symptoms and drug prescriptions in children with mite allergy. Ann Allergy Asthma Immunol. 2001;87:222–226. doi: 10.1016/S1081-1206(10)62230-2.
    1. Ciprandi G, Cosentino C, Milanese M, Mondino C. Fexofenadine reduces nasal congestion in perennial allergic rhinitis. Allergy. 2001;56:1068–1070. doi: 10.1034/j.1398-9995.2001.00191.x.
    1. Ciprandi G, Varricchio A, Capasso M, Varricchio AM, DeLucia A, Ascione E, et al. Intranasal flunisolide treatment in children with adenoidal hypertrophy. Int J Immunopathol Pharm. 2007;20:833–836. doi: 10.1177/039463200702000420.
    1. Varricchio A, Tortoriello G, Capasso M, De Lucia A, Marchisio P, Varricchio AM, et al. Prevention of surgery in children with adenoidal hypertrophy treated with intranasal flunisolide: a 12-month follow-up. J Biol Reg. 2009;23:95–101.
    1. Varricchio A, Capasso M, De Lucia F, Avvisati AM, Varricchio AM, Bettoncelli G, et al. Intranasal flunisolide treatment in patients with non-allergic rhinitis. Int J Immunopathol Pharmacol. 2011;24:401–409. doi: 10.1177/039463201102400213.
    1. Chong LY, Head K, Hopkins C, Philpott C, Burton MJ, Schilder AG. Different types of intranasal steroids for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016;4:CD011993.
    1. Passali D, Spinosi MC, Crisanti A, Bellussi LM. Mometasone furoate nasal spray: a systematic review. Multidisc Respir Med. 2016;11:18. doi: 10.1186/s40248-016-0054-3.
    1. Ciprandi G, Varricchio A. The relevance of the Mometasone Furoate nasal spray device in clinical practice. J Biol Reg. 2018;32:1051–1054.
    1. Varricchio A, Capasso M, Avvisati F, Varricchio AM, De Lucia A, Brunese FP, et al. Inhaled hyaluronic acid as ancillary treatment in children with bacterial acute rhinopharyngitis. J Biol Reg. 2014;28:537–543.
    1. Gelardi M, Taliente S, Fiorella ML, Quaranta N, Ciancio N, Russo C, et al. Ancillary therapy of intranasal T-LysYal® for patients with allergic, non-allergic, and mixed rhinitis. J Biol Res. 2016;30:255–262.
    1. Gelardi M, Taliente S, Fiorella ML, Quaranta N, De Candia N, Russo C, et al. Intranasal T-LysYal® as adjunctive therapy in patients after FESS (functional endoscopic sinus surgery) J Biol Res. 2016;30:277–284.
    1. Miraglia del Giudice M, Maiello N, Capristo C, Alterio E, Capasso M, Perrone L, Ciprandi G. Resveratrol plus carboxymethyl-b-glucan reduces nasal symptoms in children with pollen-induced allergic rhinitis. Curr Med Res Op. 2014;30:1931–1935. doi: 10.1185/03007995.2014.938731.
    1. Miraglia del Giudice M, Maiello N, Decimo F, Capasso M, Campana G, Leonardi S, Ciprandi G. Resveratrol plus carboxymethyl-β-glucan may affect respiratory infections in children with allergic rhinitis. Pediatric Allergy Immunol. 2014;25:724–728. doi: 10.1111/pai.12279.
    1. Varricchio AM, Capasso M, della Volpe A, Malafronte L, Mansi N, Varricchio A, Ciprandi G. Resveratrol plus carboxymethyl-β-glucan in children with recurrent respiratory infections: a preliminary and real-life experience. It J Pediatr. 2014;40:93. doi: 10.1186/s13052-014-0093-3.
    1. Guerra A, Varricchio A, Ciprandi G. Secondary sinonasal headache in children: an empiric approach. J Biol Reg. 2019;33:1283–1287.
    1. Varricchio A, DeLucia A, Varricchio AM, della Volpe A, Mansi N, Pastore V, et al. Sinuclean Nebules treatment in children suffering from otitis media with effusion. Int J Ped ORL. 2017;94:30–35.
    1. Marseglia GL, Licari A, Ciprandi G. A polycentric, randomized, double-blind, parallel-group, placebo-controlled study on Lertal®, a multicomponent nutraceutical, as add-on treatment in children with allergic rhinoconjunctivitis: phase I during active treatment. J Biol Reg. 2019;33:617–622.
    1. Marseglia GL, Licari A, Leonardi S, Papale M, Zicari AM, Schiavi L, Ciprandi G. A polycentric, randomized, parallel-group, study on Lertal®, a multicomponent nutraceutical, as preventive treatment in children with allergic rhinoconjunctivitis: phase II. Ital J Ped. 2019;45:84. doi: 10.1186/s13052-019-0678-y.
    1. Miraglia del Giudice M, Maiello N, Decimo F, Fusco N, D’Agostino B, Sullo N, et al. Airways allergic inflammation and L. Reuterii treatment in asthmatic children. J Bio Regulator. 2012;26:35–40.
    1. Caffarelli C, Cardinale F, Povesi-Dascola C, Dodi I, Mastrorilli V, Ricci G. Use of probiotics in pediatric infectious diseases. Expert Rev Anti-Infect Ther. 2015;3:1517–1535. doi: 10.1586/14787210.2015.1096775.
    1. Miraglia del Giudice M, Maiello N, Allegorico A, Iavazzaro L, Capasso M, Ciprandi G. Lactobacillus reuteri DSM 17938 plus vitamin D3 as ancillary treatment in allergic children with asthma. Ann Allergy Asthma Immunol. 2016;117:710–712. doi: 10.1016/j.anai.2016.09.004.
    1. La Mantia I, Varricchio A, Ciprandi G. Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis 89a nasal spray for preventing recurrent acute otitis media in children: a real-life clinical experience. Int J Gen Med. 2017;10:171–175. doi: 10.2147/IJGM.S137614.
    1. La Mantia I, Varricchio A, Ciprandi G. Is it possible to prevent adenoidectomy? Turk Arch Otolaryngol. 2018;56:129–131. doi: 10.5152/tao.2018.3352.
    1. Andaloro C, Santagati M, Stefani S, La Mantia I. Bacteriotherapy with Streptococcus Salivarius 24SMB and Streptococcus Oralis 89a Oral spray for children with recurrent streptococcal Pharyngotonsillitis: A randomized placebo-controlled clinical study. Eur Arch Otorhinolaryngol. 2019;276:879–887. doi: 10.1007/s00405-019-05346-3.
    1. Passali D, Capopello C, Passali GC, Cingi C, Sarafoleanu C, Bellussi LM. Nasal mucociliary transport time alteration: efficacy of 18 B glycyrrhetinic acid. Multidiscipl Respir Med. 2017;12:29. doi: 10.1186/s40248-017-0110-7.
    1. Cavone L, Cuppari C, Mansi S, Grasso L, Arrigo T, Calamai L, et al. Increase in the level of proinflammatory cytokine HMGB1 in nasal fluids of patients with rhinitis and its sequestration by glycyrrhizin induces eosinophil cell death. Clin Exp Otorhinolaryngol. 2025;8:123–128. doi: 10.3342/ceo.2015.8.2.123.
    1. Damiani V, Camaioni A, Viti C, Scirò AS, Morpurgo G, Gregori D. A single-Centre, the before-after study of the short- and long-term efficacy of Narivent in the treatment of nasal congestion. J Int Med Res. 2012;40:1931–1941. doi: 10.1177/030006051204000534.
    1. Mansi N, D’Agostino G, Scirè AS, Morpurgo G, Gregori D, Gulati A, et al. Allergic rhinitis in children: a randomized clinical trial targeted at symptoms. Indian J Otolaryngol Head Neck Surg. 2014;66:386–393. doi: 10.1007/s12070-014-0708-4.
    1. Licari A, Marseglia G, Ciprandi G. New pharmacologic strategies for allergic rhinitis. Curr Treat Options Allergy. 2016;3:495. doi: 10.1007/s40521-016-0105-1.
    1. Vlastos I, Gkouskou K, Doulaptsi M, Karatzanis A, Prokopakis EP. Precision medicine in rhinosinusitis. Curr Allergy Asthma Rep. 2019;19:12. doi: 10.1007/s11882-019-0850-x.
    1. Ren L, Zhang N, Zhang L, Bachert C. Biologics for the treatment of chronic rhinosinusitis with nasal polyps – state of the art. World Allergy Organ J. 2019;12:100050. doi: 10.1016/j.waojou.2019.100050.
    1. Glickstein JS, Chandra RK, Thompson JW. Intracranial complications of pediatric sinusitis. Otolaryngol Head Neck Surg. 2006;134:733–736. doi: 10.1016/j.otohns.2005.12.001.

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