Clinical Utility Of The Exhaled Nitric Oxide (NO) Measurement With Portable Devices In The Management Of Allergic Airway Inflammation And Asthma

Journal of Asthma and Allergy

Volume 2019:12 Pages 331—341

DOI https://doi.org/10.2147/JAA.S190489

Sy Duong-Quy<sup>1,2

1</sup>Department of Respiratory Diseases, Medical and Biological Research Centre, Lam Dong Medical College, Dalat City, Lam Dong Province, Vietnam; ²Department of Immuno-Allergology, Penn State Medical College, Hershey, PA, USA

Abstract: Nitric oxide (NO) is a potential bioactive gas produced continuously and constantly in the airways of healthy subjects. In allergic airway inflammation, the level of exhaled NO is usually increased and mediated by inducible nitric oxide synthase (iNOS) enzyme presenting in the epithelium and different inflammatory cells. The measurement of NO concentration in the airway is possible with portable devices which use an electroluminescence technique. In subjects with upper airway with allergic inflammation such as in allergic rhinitis, the measurement of nasal NO (nNO) may help to diagnose and manage the disease. In the lower airway, increased fractional exhaled NO (FENO) reflects directly the inflammatory process that occurs in the airways that are typically seen in asthma.

Origin of nasal NO and technique of nNO measurement.
Exhaled NO is produced from the epithelial cells, eosinophils,
 mast cells, and other cells under the activity of iNOS
 during contact with allergens. The measurement of nNO
is done by introducing the sampling catheter to the nasal
cavity via the nostril to aspirate the internal air stream. 

It has been shown that there is a strong correlation between FENO levels and increased activity of airway inflammation mediated by immuno-allergic cells and mediators. Thus, FENO has higher specificity and sensitivity than other methods in diagnosing the severity of inflammation in asthmatic patients. Moreover, the correlation between increased FENO levels and a high risk of bronchial hyperresponsiveness has also been demonstrated. FENO is also a relevant biomarker to evaluate asthma status due to the change of its values occurring earlier than clinical manifestations and spirometry parameters. In addition, the measurement of FENO with portable devices helps to support the diagnosis of asthma, to follow-up the control of asthma and to personalize asthmatic patients for target treatment with biologic therapy. Therefore, measuring FENO with portable devices in the diagnosis and treatment of allergic airway inflammation, especially in asthma, is one of the most essential applications of NO biomarkers in exhaled breath.

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Myths, facts and controversies in the diagnosis and management of anaphylaxis

Review

Katherine Anagnostou, Paul J Turner

Abstract

Anaphylaxis is a serious systemic allergic reaction that is rapid in onset and may cause death. Despite numerous national and international guidelines and consensus statements, common misconceptions still persist in terms of diagnosis and appropriate management, both among healthcare professionals and patient/carers. We address some of these misconceptions and highlight the optimal approach for patients who experience potentially life-threatening allergic reactions.

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CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria

• Review
• Open Access

• Allergy, Asthma & Clinical Immunology

• Michael N. Fein, 
• David A. Fischer, 
• Andrew W. O’Keefe & 
• Gord L. Sussman 

Allergy, Asthma & Clinical Immunologyvolume 15, Article number: 61 (2019)  

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Abstract

Oral H1-antihistamines (AHs) are the most commonly used therapy to treat allergic rhinitis and chronic urticaria. Older, first-generation AHs (e.g. diphenhydramine, hydroxyzine) have significant and common side effects including sedation, impairment with decreased cognitive function, poor sleep quality, dry mouth, dizziness, and orthostatic hypotension. These drugs have also been found to result in death from accidents, intentional or unintentional overdoses, and sudden cardiac death.

Indoor exposure to particulate matter and volatile organic compounds in dwellings and workplaces and respiratory health in French farmers

• Original research article
• Open Access
• 
  

• Cara Nichole Maesano, 
• Denis Caillaud, 
• Hassani Youssouf, 
• Soutrik Banerjee, 
• Julie Prud’Homme, 
• Christelle Audi, 
• Kigninlman Horo, 
• Yacouba Toloba, 
• Ollivier Ramousse & 
• Isabella Annesi-Maesano 

Multidisciplinary Respiratory Medicinevolume 14, Article number: 33 (2019) | 

Abstract

Introduction

Few investigations have related objective assessments of indoor air pollutants to respiratory health in farmers, in spite of the many rural environmental hazards to which they are exposed. Chemical air pollution has been particularly neglected.

Biomarkers In Chronic Spontaneous Urticaria: Current Targets And Clinical Implications

REVIEW

          

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Authors Puxeddu I, Petrelli F, Angelotti F, Croia C, Migliorini P

 Journal of Asthma and Allergy Volume 2019:12 Pages 285—295

DOI https://doi.org/10.2147/JAA.S184986

Abstract: Chronic urticaria (CU) is a mast cell-driven disease characterized by the development of wheals, angioedema, or both for more than 6 weeks. The two major sub-types are chronic spontaneous urticaria (CSU) and inducible urticaria. In the last decade different pathophysiological mechanisms, potentially responsible for the development of the disease, have been described.

Engaging and Educating Patients to Improve AD Care: A Practical Toolkit for Clinical Teams

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• ACTIVITY OVERVIEW

Intended Audience: Physicians, Nurse Practitioners, Physician Assistants, and Nurses

Did you know that patients who learn about their own health conditions and partner with their clinical teams to decide on the best treatments are much happier and achieve better outcomes with their care?

This inclusive guide provides clinicians with materials and resources to engage and educate patients, individually or through group education, about atopic dermatitis (AD) and help build a strong foundation for informed decision-making regarding treatment goals, preferences, and plans.

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The Skin in Celiac Disease Patients: The Other Side of the Coin

Medicina 2019, 55(9), 578; https://doi.org/10.3390/medicina55090578

Review

by Ludovico Abenavoli 1,*,Stefano Dastoli 2,Luigi Bennardo 2,Luigi Boccuto 3,4,Maria Passante 2,Martina Silvestri 2,Ilaria Proietti 5,Concetta Potenza 5,Francesco Luzza 1 andSteven Paul Nisticò 2

Abstract

: 

Celiac disease (CD) is an autoimmune enteropathy that primarily affects the small intestine and is characterized by atrophy of intestinal villi. The manifestations of the disease improve following a gluten-free diet (GFD). CD is associated with various extra-intestinal diseases. Several skin manifestations are described in CD patients. The present paper reviews all CD-associated skin diseases reported in the literature and tries to analyze the pathogenic mechanisms possibly involved in these associations.

Is chronic urticaria more than skin deep?

• Clinical and Translational Allergy
• Review
• 
  
• Open Access

• Emek Kocatürk & 
• Clive Grattan 

volume

  

Clinical and Translational Allergy 9, Article number: 48 (2019) |

Abstract

Involved systems in chronic urticaria and relevant manifestations

Chronic urticaria is a disease characterized by the appearance of weals, angioedema or both longer than 6 weeks. Degranulation of cutaneous or submucosal mast cells leads to release of mediators including histamine resulting in redness, swelling and itch. Because mast cells are widely distributed throughout the body, the question is why they are not activated systemically or does systemic activation occur without overt end organ dysfunction?