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    Challenges in rhinology
    (Springer International Publishing, 2020) Cingi, Cemal; Bayar Muluk, Nuray; Scadding, Glenis K.; Mladina, Ranko
    This book examines in detail many rhinologic issues that are not covered in other books, are still not completely understood, and can be difficult to deal with clinically In each chapter, three authors - a young otorhinolaryngologist, a senior author, and an international expert - elaborate on a specific issue, such as the role of immunotherapy in treating nasal polyps, the management of rhinitis during pregnancy, how rhinitis can differ in adults and children, how to choose between open or endonasal rhinoplasty, the ideal form of anesthesia for nasal surgery, etc The volume will appeal to a wide readership, from otorhinolaryngologists to allergists and facial plastic surgeons, as well as trainees and students in related fields. © Springer Nature Switzerland AG 2021.
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    Does aspirin desensitisation work in N-ERD?
    (Springer International Publishing, 2020) Çakmak Karaer, Işil; Bayar Muluk, Nuray; Scadding, Glenis K.
    Aspirin (ASA, acetylsalicylic acid) has the most widespread use of any medication in the world. It plays a key role in the management of cardiovascular disease, especially acute coronary syndromes (ACS) and chronic ischaemic heart disease (CIHD). It is used to prevent stroke and in the management of certain chronic rheumatological disorders. Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD), also referred to as Samter's triad, affects both the upper and lower airways and involves sinusitis of eosinophilic type, severe nasal polyp formation, asthma and hypersensitivity to COX-1-inhibiting drugs. It is an inflammatory disease of escalating severity. Of N-ERD sufferers, 75% are also sensitive to alcohol. N-ERD has a frequency of between 0.6% and 2.5% in general and is seen in 40% of cases where the patient develops asthma in adulthood and has chronic sinusitis with nasal polyposis (CRS(+)NP). The disorder is classified as progressive. The most common age for it to occur is age 30-34, and it is more usual in females than males. The initial presentation of N-ERD is frequently a flu-like illness that develops into persistent rhinosinusitis; then, asthma signs develop and finally frank respiratory system sensitivity to aspirin and NSAIDs. In this chapter, aspirin desensitisation and N-ERD are reviewed. © Springer Nature Switzerland AG 2021.
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    Recent combination therapy options for allergic rhinitis
    (Springer International Publishing, 2020) Kef, Kemal; Bayar Muluk, Nuray; Konstantinidis, Iordanis; Scadding, Glenis K.
    Treatment should be initially preventive through allergen and pollutant avoidance as much as possible. For pollen allergy, it is beneficial to stay away from outdoor activities during the seasons with high pollen density and not to open doors and windows in the morning and evening hours when pollen levels are highest. If the patient has outdoor activities, it is better to remove the clothes upon entering the home, have a shower and wash the hair. Air conditioners should have a pollen filter working by recirculating the room air. Nasal pollen filters and balms can reduce symptoms by about a third. There can be significant improvement in few patients by allergen avoidance alone. Most need additional pharmacotherapy. Those with uncontrolled symptoms may be candidates for allergen-specific immunotherapy (AIT). Pharmacotherapy does not change the course of the disease; medications only prevent or reduce symptoms. AIT has been shown to reduce symptoms even after discontinuation, to decrease progression from AR to asthma and to reduce new sensitisations. In this chapter, recent combination therapy options for allergic rhinitis are reviewed. © Springer Nature Switzerland AG 2021.
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    Will every child have allergic rhinitis soon?
    (Elsevier Ireland Ltd, 2019) Cingi, Cemal; Muluk, Nuray Bayar; Scadding, Glenis K.
    Objectives: Given the increasing prevalence of AR amongst children, we aimed to review the literature regarding the future of AR in this population. Methods: We searched the PubMed, Google and Proquest Central databases at Kirikkale University Library. Search terms used were: "allergic rhinitis", "children", "paediatric", "allergy", "future", "risk factors", "treatment", "pharmacotherapy" and/or "allergen specific immunotherapy". With regard to risk factors for allergic rhinitis, the terms "Environmental factors", "Improved hygiene", "Increased indoor allergen exposure", "Farms, villages, worms, and other parasites", "Environmental toxicants", "Diet", "Lifestyle changes", "Air pollution" and "Climate factors" were searched for. "Prevention of allergic diseases" and "Allergen-specific immunotherapy in the future" were also included in the search. Results: AR has a high prevalence and causes considerable morbidity, has associated comorbidity and features specific complications. The principal treatments rely on avoiding the allergens responsible, and administering drug treatment or immunotherapy, which targets specific antigens. Genetic drift does not explain the rising prevalence of allergic disorders, but multifactorial environmental factors are likely culprits. Amongst such environmental factors to consider are the rise in caesarean births, decreases in breast feeding, dietary changes resulting in less fresh produce being consumed, the eradication of intestinal worm infestations, alterations in the way homes are aired and heated, children taking less exercise and being outdoors for shorter periods, whilst also having more contact with pollution. Conclusion: Barring substantial lifestyle alterations, more and more children are likely to develop AR. It may prove feasible to stop allergy developing in the first place through manipulation of the microbiome, but the exact format such a modification should involve remains to be discovered. Molecular allergological techniques do offer the prospect of more precisely targeted immunotherapy, the sole disease modifier at present. However, at present the complexity and cost of such interventions prevents their widespread use and research in this area is still needed. The majority of children with AR are going to be managed using nasal saline sprays, since they are the most straightforward and least risky alternative for first line treatment.