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    Do probiotics have a role in the treatment of allergic rhinitis? A comprehensive systematic review and meta-analysis
    (Sage Publications Inc, 2016) Guvenc, Isil Adadan; Muluk, Nuray Bayar; Mutlu, Fezan Sahin; Eski, Erkan; Altintoprak, Niyazi; Oktemer, Tugba; Cingi, Cemal
    Objective: To investigate clinical evidence for the efficacy of probiotics in the treatment of allergic rhinitis (AR). Methods: A systematic search was conducted to review the results of all randomized, double-blind, placebo-controlled trials by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Primary outcome measurements were total nasal and ocular symptom scores (SS) and quality of life (QoL) questionnaires. Secondary outcome measurements were individual nasal SS and immunologic parameters. Results: Twenty-two randomized, double-blind, placebo-controlled studies were included. Seventeen trials showed significant benefit of probiotics clinically, whereas eight trials showed significant improvement in immunologic parameters compared with placebo. All five studies with Lactobacillus paracasei (LP) strains demonstrated clinically significant improvements compared with placebo. Probiotics showed significant reduction in nasal and ocular SS (standardized mean difference [SMD], -1.23, p < 0.001; and SMD, -1.84, p < 0.001; respectively), total, nasal, and ocular QoL scores compared with placebo (SMD, -1.84, p < 0.001; SMD, -2.30, p = 0.006; and SMD, -3.11, p = 0.005; respectively). Although heterogeneity was high, in subgroup analysis, SMD for total nasal and ocular symptoms with patients with seasonal AR and for nasal QoL scores for studies with LP-33 strain were significant and homogenous. Scores of nasal blockage, rhinorrhea, and nasal itching were significantly lower in the probiotic group compared with placebo. The meta-analysis studies SS the Japanese guidelines revealed a significant, homogenous SMD score of -0.34 for individual nasal SS, above the minimal important clinical difference value of 0.3. The T-helper 1 to T-helper 2 ratio was significantly lower in the probiotic group compared with placebo (SMD, -0.78; p = 0.045). Conclusion: Despite high variability among the studies, synthesis of available data provided significant evidence of beneficial clinical and immunologic effects of probiotics in the treatment of AR, especially with seasonal AR and LP-33 strains. With the rising pool of studies, the most promising strains in specific allergies can be revealed and adjuvant therapy with probiotics can be recommended for the treatment of AR.
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    A pastille combining myrrh tincture, peppermint oil and menthol to treat the upper airway
    (Deomed Publ, Istanbul, 2015) Oktemer, Tugba; Ipci, Kagan; Muluk, Nuray Bayar; Cingi, Cemal
    Myrrh and borax (combined in a tincture) can be used as a mouthwash. Myrrh gum is used to treat indigestion, ulcers, colds, coughs, asthma, lung congestion, arthritis pain, and cancer. Myrrh has been shown to exert analgesic effects on mice in which pain was induced. Myrrh is used as an astringent, antiseptic (to treat inflammed lesions of the throat and mouth), and antispasmodic to treat cancer and infectious disease. In this paper, we review the literature on myrrh tinctures, peppermint oil, and menthol.
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    Update on local allergic rhinitis
    (Elsevier Ireland Ltd, 2016) Altintoprak, Niyazi; Kar, Murat; Muluk, Nuray Bayar; Oktemer, Tugba; Ipci, Kagan; Birdane, Leman; Cingi, Cemal
    We here provide an update on the literature regarding local allergic rhinitis (LAR). In reviewing LAR, we have included an updated definition, classifications, mechanisms, comorbidities, and recommendations for diagnosis and treatment for LAR, as well as the defined research areas for future evidence-based studies. LAR is a localised nasal allergic response in the absence of systemic atopy characterised by local production of specific IgE (sIgE) antibodies, a TH2 pattern of mucosal cell infiltration during natural exposure to aeroallergens, and a positive nasal allergen provocation test response, with the release of inflammatory mediators. The localised allergic response of LAR is an important topic for the study of allergies. This review provides an update on the current knowledge of LAR. (C) 2016 Elsevier Ireland Ltd. All rights reserved.