Rhinophototherapy: A new therapeutic tool for the management of allergic rhinitis

doi:10.1016/j.jaci.2004.11.005

Journal of Allergy and Clinical Immunology

Volume 115, Issue 3, March 2005, Pages 541-547

https://doi.org/10.1016/j.jaci.2004.11.005 Get rights and content

Background

Phototherapy has a profound immunosuppressive effect and is able to inhibit hypersensibility reactions in the skin.

Objective

We evaluated whether phototherapy using a combination of UV-B (5%), UV-A (25%), and visible light (70%), referred to as mUV/VIS, is effective in treating allergic rhinitis.

Methods

We conducted a randomized, double-blind study, in 49 patients with hay fever. The study was performed during the ragweed season. Each intranasal cavity was illuminated 3 times a week for 3 weeks with mUV/VIS or with low-intensity visible light. Symptom scores, inflammatory cells, and their mediators were assessed in nasal lavages. In vitro effects of mUV/VIS irradiation on T-cell and eosinophil apoptosis and its inhibitory effect on mediator release from basophils were examined.

Results

Rhinophototherapy was tolerated well and resulted in a significant improvement of clinical symptoms for sneezing (P < .016), rhinorrhea (P < .007), nasal itching (P < .014), and total nasal score (P < .004). None of the scores improved significantly in the control group. Scores for nasal obstruction slightly improved after mUV/VIS treatment and significantly increased in the control group (P < .017). In the nasal lavage, phototherapy significantly reduced the number of eosinophils and the level of eosinophil cationic protein and IL-5. In vitro irradiation of T cells and eosinophils with mUV/VIS light dose-dependently induced apoptosis. Furthermore, mUV/VIS irradiation inhibited the mediator release from RBL-2H3 basophils.

Conclusion

These results suggest that phototherapy is an effective modality to treat allergic rhinitis and offer new options for the treatment of immune-mediated mucosal diseases.

Section snippets

Study design for rhinophototherapy

We conducted a randomized, double-blind study in patients with a history of at least 2 years of moderate to severe ragweed-induced allergic rhinitis that was not controlled by antiallergic drugs. Positive SPT results and an elevated level of ragweed-specific IgE antibody confirmed the diagnosis. The Ethical Committee of Szeged University approved the protocol. All patients gave their written informed consent. We excluded potential subjects from the study if they had any significant nasal

Effects of phototherapy on clinical symptoms of allergic rhinitis

Forty-nine patients received intranasal phototherapy, either with mUV/VIS light (25 patients) or l-VIS (24 patients). The 2 groups did not differ in age, disease duration, or clinical scores at the beginning of treatment protocol (see Table EI in the Online Repository at www.mosby.com/jaci). TNS significantly decreased after mUV/VIS (P = .004) and slightly increased after l-VIS treatment (P > .05; (Fig 1, A). In the mUV/VIS group, the individual scores decreased compared with baseline for sneezing (

Discussion

The goal of our study was to assess the efficacy of phototherapy in allergic rhinitis. Our data reveal that mUV/VIS significantly suppressed the clinical symptoms of allergic rhinitis. Phototherapy locally reduced the number of inflammatory cells and the level of mediators. Rhinophototherapy was tolerated well and significantly reduced the clinical scores for sneezing, rhinorrhea, and nasal itching as well as the TNS.

Recently, we could show in a pilot study that intranasal phototherapy with

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Intranasal low-level laser therapy (LLLT) has already proven its immunosuppressive effects on allergic rhinitis (AR) in experimental studies; however, there is a dearth of clinical evidence supporting its effects in treating AR. The aim of this study was to assess the safety and effectiveness of intranasal LLLT in the treatment of AR compared with acupuncture.
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Allergic rhinitis is a chronic inflammatory disease of the nasal mucosa, mediated by immunoglobulin E, affecting 1 in 6 individuals. The treatment aims at attaining symptomatic control with minimal side effects, a requirement for new alternative therapies, including phototherapy, as it has an immunosuppressive and immunomodulatory effect.
To identify the effectiveness of phototherapy in the treatment of allergic rhinitis through a meta-analysis.
We searched Web of Science, Scielo, PubMed, SCOPUS, PEDro, and LILACS databases, using the terms: “intranasal irradiation”, “phototherapy” and “allergic rhinitis”. The R software Metafor package was used for the meta-analysis and the effect size was calculated for each symptom individually.
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Considering the effect size and the statistical significance attained in our study, rhinophototherapy showed to be an effective treatment for reducing the nasal symptom scores triggered by AR.
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It has shown promising results in adults and is currently undergoing evaluation in pediatric patients.186 Devices beaming inside the nose certain wavelengths of visible and infrared light have been shown to reduce the symptoms and improve HRQoLin subjects with allergic rhinitis to both outdoor and indoor allergens.187–190 Attempts of using conventional laser treatment for allergic rhinitis have been initiated in the 1990s.
Medical devices provide people with some health benefits in terms of diagnosis, prevention, treatment, and monitoring of disease processes. Different medical specialties use varieties of medical devices more or less specific for them. Allergology is an interdisciplinary field of medical science and teaches that allergic reactions are of systemic nature but can express themselves at the level of different organs across the life cycle of an individual. Subsequently, medical devices used in allergology could be regarded as: 1) general, servicing the integral diagnostic and management principles and features of allergology, and 2) organ specific, which are shared by organ specific disciplines like pulmonology, otorhinolaryngology, dermatology, and others. The present position paper of the World Allergy Organization (WAO) is meant to be the first integral document providing structured information on medical devices in allergology used in daily routine but also needed for sophisticated diagnostic purposes and modern disease management. It is supposed to contribute to the transformation of the health care system into integrated care pathways for interrelated comorbidities.
Effects of irradiation with narrowband-ultraviolet B on up-regulation of histamine H<inf>1</inf> receptor mRNA and induction of apoptosis in HeLa cells and nasal mucosa of rats
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The method included a combination of containing UVB (5%), UVA (25%) and visible light (70%) into the nasal cavity. It was reported that Rhinolight suppressed eosinophilic cationic protein and IL-5 in the nasal discharge by inducing apoptosis of T cells and eosinophils.41 In contrast, our phototherapy with intranasal irradiation with low cumulative dose of NB-UVB suppressed nasal symptom by its inhibitory effect on the up-regulation of H1R mRNA in the nasal mucosa without induction of apoptosis, unlike Rhinolight.
Narrowband-ultraviolet B (NB-UVB) phototherapy is used for the treatment of atopic dermatitis. Previously, we reported that irradiation with 200 mJ/cm² of 310 nm NB-UVB suppressed phorbol-12-myristate-13-acetate (PMA)-induced up-regulation of histamine H₁ receptor (H1R) gene expression without induction of apoptosis in HeLa cells. However, the effect of NB-UVB irradiation on nasal symptoms is still unclear. Here, we show that low dose irradiation with 310 nm NB-UVB alleviates nasal symptoms in toluene 2,4-diisocyanate (TDI)-sensitized allergy model rats. Irradiation with 310 nm NB-UVB suppressed PMA-induced H1R mRNA up-regulation in HeLa cells dose-dependently at doses of 75–200 mJ/cm² and reversibly at a dose of 150 mJ/cm² without induction of apoptosis. While, at doses of more than 200 mJ/cm², irradiation with 310 nm NB-UVB induced apoptosis. Western blot analysis showed that the suppressive effect of NB-UVB irradiation on H1R gene expression was through the inhibition of ERK phosphorylation. In TDI-sensitized rat, intranasal irradiation with 310 nm NB-UVB at an estimated dose of 100 mJ/cm² once a day for three days suppressed TDI-induced sneezes and up-regulation of H1R mRNA in nasal mucosa without induction of apoptosis. These findings suggest that repeated intranasal irradiation with low dose of NB-UVB could be clinically used as phototherapy of AR.
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Supported by a grant of the Hungarian Ministry of Health (ETT-419/2003) and a grant of the Hungarian Ministry of Education (OMFB-01620) to Dr Kemeny.

Disclosure of potential conflict of interest: Lajos Kemeny, Attila Dobozy, Zsolt Bor, Gabor Szabo, and Ferenc Ignacz are cofounders of a company that will produce the light source for treatment and have submitted a patent application on this topic (patent pending).

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Rhinitis, sinusitis, and ocular diseasesRhinophototherapy: A new therapeutic tool for the management of allergic rhinitis

Background

Objective

Methods

Results

Conclusion

Section snippets

Study design for rhinophototherapy

Effects of phototherapy on clinical symptoms of allergic rhinitis

Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

Lancet

J Photochem Photobiol B

Clin Dermatol

J Invest Dermatol

J Photochem Photobiol B

J Photochem Photobiol B

J Photochem Photobiol B

J Invest Dermatol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Biochem Pharmacol

Allergy and allergic diseases: first of two parts

N Engl J Med

Rhinitis, sinusitis, and ocular diseases
Rhinophototherapy: A new therapeutic tool for the management of allergic rhinitis