Intranasal corticosteroids for XXXX : biological rationale, efficacy, and safety.

@entity32 @entity225 @entity2023 @entity1127 @entity565 @entity117 @entity566 @entity4 @entity910 @entity2490 @entity56 @entity112 @entity1412 @entity528 @entity1577
@entity1412 , occurring in about 2% of the general population, is the ultimate form of @entity32 of the upper airways. For unknown reasons, @entity1127 develop preferentially in subtypes of @entity32 and are associated with perennial @entity2023 , @entity565 , intolerance of @entity117 ( @entity117 )/NSAIDs, @entity56 , @entity1577 , and primary @entity910 . In contrast to common beliefs, IgE-mediated @entity566 does not seem to play an etiological role in @entity1412 .The @entity1127 originate from the mucosa around the clefts of the lateral nasal wall, especially in the region of the ostiomeatal complex. The factors that determine the localization of the disease to a few square centimeters of the airways are not known. @entity1127 are @entity4 bags covered by respiratory epithelium and contain very few nerves, blood vessels, and glands that have undergone @entity528 . They contain degranulated mast cells, have a very high concentration of @entity112 , and are characteristically infiltrated by eosinophils. These cells accumulate due to the release of proinflammatory cytokines (in particular, @entity225 ). @entity1412 is preceded by a prolonged history of @entity2490 accompanied by severe and persistent nasal blockage; typically, the sense of smell is seriously impaired when @entity1127 develop. The diagnosis is based on anterior rhinoscopy or, preferably, endoscopy. @entity1412 is medically treatable. Surgical treatment is carried out when medication fails. Intranasal corticosteroids reduce @entity2490 , improve nasal breathing, reduce the size of @entity1127 , and prevent, in part, their recurrence, but this treatment has little effect on the sense of smell. Intranasal corticosteroids can, as basic long-term therapy, be used alone in mild cases or together with systemic corticosteroids and/or surgery in severe cases. Systemic corticosteroids administered for 2-3 weeks have a beneficial effect on all observed symptoms and pathology, including the sense of smell. When nasal blockage is a problem in spite of medical treatment, surgery is recommended. Simple polypectomy can be performed, but endoscopic surgery is recommended in more severe and persistent cases.
