Clinical Research ENT Updates 2015;5(1):35–40 doi:10.2399/jmu.2015001009 A preliminary report on the prevalence and clinical features of allergic rhinitis in ankylosing spondylitis patients Arif Turgan1, Ahmet Ural1, Abdülcemal Ümit Ifl›k1, Selçuk Arslan1, Erhan Çapk›n2, Refik Ali Sar›3 1Department of Otorhinolaryngology, Medical School, Karadeniz Technical University, Trabzon, Turkey 2Department of Physical Medicine and Rehabilitation, Medical School, Karadeniz Technical University, Trabzon, Turkey 3Department of Clinical Immunology, Medical School, Karadeniz Technical University, Trabzon, Turkey Abstract Özet: Ankilozan spondilit hastalar›nda alerjik rinit s›kl›¤› ve klinik özelliklerine iliflkin bir ön çal›flma Objective: Our aim was to investigate the prevalence and clinical fea- Amaç: Bu çal›flman›n amac› ankilozan spondilit hastalar›nda alerjik tures of allergic rhinitis in patients with ankylosing spondylitis. rinit s›kl›¤› ve klinik özelliklerini araflt›rmakt›r. Methods: This cross-sectional, clinical study was performed on 64 Yöntem: Bu kesitsel, klinik çal›flma bir üniversite hastanesinin kulak patients (24 females, 40 males) between October 2011 and November burun bo¤az hastal›klar› klini¤inde Ekim 2011 – Kas›m 2012 aras›n- 2012. The Score for Allergic Rhinitis (SFAR) questionnaire was carried da gerçeklefltirildi. Toplam 64 ankilozan spondilit hastas›na (24 kad›n, out to the patients with a recent diagnosis of ankylosing spondylitis. 40 erkek) “The Score for Allergic Rhinitis” (SFAR) anketi uyguland›. Skin prick test was performed to the cases who responded positively to Anket sonucuna göre alerjik rinit oldu¤u düflünülen olgulara deri tes- SFAR. Descriptive parameters, clinical features and skin prick test ti yap›ld›. Tan›mlay›c› parametreler, klinik özellikler ve deri testi bul- results were documented. gular› analiz edilerek sunuldu. Results: The mean age of the study group was 41.7±11.2. Eight Bulgular: Çal›flma grubunda ortalama yafl 41.7±11.2 olarak bulundu. patients (12.5%) were presumably diagnosed for allergic rhinitis Anket sonucuna göre alerjik riniti oldu¤u düflünülen 8 hastaya (%12.5) according to SFAR questionnaire. Skin prick test yielded positivity deri testleri yap›ld›. Deri testi sonucunda bu olgulardan yaln›zca birin- for Dermatophagoides farinae and Dermatophagoides pteronyssinus in one de Dermatophagoides farinae ve Dermatophagoides pteronyssinus için pozi- of the 8 cases who responded positively for SFAR. The most common tiflik saptand›. Ankilozan spondilit hastalar›nda rinitle ilgili olabilecek symptoms were sneezing (n=15; 23.4%), nasal obstruction (n=12; klinik bulgulardan hapfl›rma (n=15; %23.4), burun t›kan›kl›¤› (n=12; 18.8%), and nasal itching (n=12; 18.8%). 18.8%) ve burun kafl›nt›s› (n=12; %18.8) gözlendi. Conclusion: Our results demonstrate that prevalence of allergic rhini- Sonuç: Çal›flmam›z›n sonuçlar›na göre ankilozan spondilit olgular›n- tis is lower in ankylosing spondylitis patients. However, clinical and da alerjik rinit s›kl›¤›n›n daha düflük oldu¤u gözlenmifltir. Otoimmün pathophysiological features of allergic rhinitis accompanying autoim- hastal›klarda alerjik rinit s›kl›¤› ve klinik bulgular›na iliflkin daha ileri mune diseases must be investigated in further trials. çal›flmalara gereksinim bulunmaktad›r. Keywords: Allergic rhinitis, ankylosing spondylitis, prevalence, symp- Anahtar sözcükler: Alerjik rinit, ankilozan spondilit, prevalans, sitokin- tom, cytokines. ler. Allergic rhinitis (AR) is a common disorder that constitutes work/school performance and the links with other comor- a considerable burden both for the individual patient and bidities. Its prevalence is estimated as 5–40% with a tenden- the society. It is important due to its high prevalence, cy to increase.[1,2] Beyond the data collected from studies per- adverse effects on the quality of life and sleep, impairment of formed on large populations, an important contribution to Correspondence: Ahmet Ural, MD. Department of Otorhinolaryngology, Medical School, Online available at: Karadeniz Technical University, Trabzon, Turkey. www.entupdates.org e-mail: [email protected] doi:10.2399/jmu.2015001009 QR code: Received: February 18, 2015; Accepted: March 2, 2015 ©2015 Continuous Education and Scientific Research Association (CESRA) Turgan A et al. the accumulation of knowledge on AR may be obtained by non-allergic or other forms of rhinitis, nasal polyposis, the epidemiological studies conducted in specific subgroups. paranasal sinus tumors, septal deviation, turbinate hyper- Symptoms of allergic rhinitis occur due to an IgE medi- trophy, history of sino-nasal surgery, and use of systemic ated inflammatory immune response. Pathophysiology is or nasal medications (steroids, decongestants or antihista- based on the secretion of cytokines due to an imbalance mines) within last 4 weeks. Routine otorhinolaryngologi- between allergen specific T helper 1 (Th1) and Th2 cells.[3] cal examination involving nasal endoscopy was made for The allergic reaction cascade is triggered with the contact of ruling out conditions consistent with exclusion criteria. allergen with IgE on mast cells and basophils. Predominance In this study, the Score for Allergic Rhinitis (SFAR) of Th2 cells and cytokines secreted from these cells sustain questionnaire, which has recently been used for estimation the subsequent allergic process. Key pathogenetic features of of AR prevalence in our country, was applied (Appendices allergic rhinits are raised levels of IgE and a characteristic Th A, B).[1,2] In the study, a SFAR score ≥7 was accepted to cell cytokine pattern.[3,4] suggest the presence of AR. Ankylosing spondylitis (AS) is a systemic in?ammatory Patients recently diagnosed as AS completed the SFAR disease that involves the axial skeleton, the peripheral questionnaire (Appendix A). The AR symptoms of blocked joints, the eye, and occasionally the aortic root may also be nose, nasal discharge, sneezing and itchy eyes were ques- affected. Ankylosing spondylitis affects primarily the joints tioned and the total SFAR score was calculated by sum- of the hand and feet in a symmetrical fashion and the pri- ming the scores of different items according to the ques- mary site of in?ammation seems to be the enthesis and tionnaire (Appendix B). Each item in the questionnaire has sites where ligaments insert into bone. The onset of AS is a number of point and the total score range from 0 to 16.[1] usually observed in the second or third decades and men Skin prick test (ALK Abello A/S, Horsholm, Denmark) was are affected more than women. Similar to allergic rhinitis, [5,6] performed on 8 patients who responded positively to SFAR ankylosing spondylitis results in substantial morbidity. questionnaire. A 20-item test was applied to the skin over- While atopic disorders are associated with a predomi- lying the ventral surfaces of the arms of patients and the nant Th2 cytokine pattern, the cytokine pattern of AS can diameter of enduration was measured 15 minutes after the be described as an “impaired Th1 cytokine pattern”.[7] application (Box 1). Diameters ≥3 mm was accepted as pos- Impairment of physiological immune response and Th1 itive according to the instructions of the manufacturer. function may be accompanied with a relatively amplified Th2 activity. Based on the reciprocal inhibition of the development of Th1 and Th2 responses, it has been sug- Box 1. Allergens used in skin prick test. gested that Th1 and Th2 polarized immune responses and Trees mix (Alnus, Betula, Corylus) diseases mutually exclude each other.[7,8] Olea europaea In summary, the aim of the current study was to inves- Populus nigra tigate the prevalence and clinical features of allergic rhini- Quecus robur tis in AS patients in Trabzon, Turkey. Pollens IV (Dactylis, Festuca, Lolium, Phelum, Poa) Pollens III (Avena, Hordeum, Triticum, Seceale) Patients and Methods Seceale cereale Study Design Pollens V (Artemisia, Chenopodium, Pariteria, Plantago) Artemisia vulgaris This cross-sectional, clinical study was performed between Pariteria Judaica January 2011 and October 2012 in the otorhinolaryngolo- Alternaria alternata gy department of our tertiary care center. Adherence to Aspergillus fumigatus the guidelines of the Declaration of Helsinki of 1975, as Dermatophagoides farinae revised in 2008, was accomplished. The approval of local Dermatophagoides pteronyssinus Institutional Review Board and written informed consent Dog epithelia from all participants were obtained. Feather mix Patients with a recent diagnosis of AS in either clinical Cat epithelia immunology or physical medicine and rehabilitation Blatella germanica departments of our tertiary care center were recruited. Saline solution Exclusion criteria were previous diagnoses of allergic, Histamine 36 ENT Updates A preliminary report on the prevalence and clinical features of allergic rhinitis in ankylosing spondylitis patients Descriptive parameters and frequency of clinical symp- Comparison of AS patients who responded negatively toms of AR were noted and compared in AS patients with or positively to SFAR with respect to descriptive and clin- and without AR. ical variables is plotted in Table 1. No difference was noted regarding distribution of age (p=0.161) and gender Statistical Analysis (p=0.460). Symptomatologic analysis has shown the fre- Statistical Package for Social Sciences (SPSS version 13.0; quencies of nasal congestion (p=0.035), nasal discharge SPSS Inc., Chicago, IL, USA) was used for analysis of (p=0.016), nasal itching