Abstract: . . .  inflammatory mediators. 27 The anatomic connection between the upper and lower airways suggests a possible role of nasal drippings in eliciting bronchial hyperreactivity in patients with allergic rhinitis or rhinosinusitis. 28 In one study, radiolabeled aerosol used to deliver allergen intranasally could not be detected in the lower airways, suggesting that allergen deposited in the upper airways did not seed the lower airways. However, allergens and inflammatory mediators may be absorbed systemically from the nasal mucosa and affect the lower airways. 29 An early study 30 investigating the integrated airway hypoth- esis suggested a nasobronchial reflex arc as a potential mecha- nism linking upper and lower airway disorders. Based on this hypothesis, nasal allergen challenge affects bronchial hyper- responsiveness through a reflex arc that involves trigeminal  . . .
. . .  therapeutic reference sum- mary. Manag Care Interface. 1999;12:70-77. 66. Rachelefsky GS, Katz RM, Siegel SC. Chronic sinus disease with associated reactive airway disease in children. Pediatrics. 1984;73:526-29. 67. Friedman R, Ackerman M, Wald E, Casselbrant M, Friday G, Fireman P. Asthma and bacterial sinusitis in children. J Allergy Clin Immunol. 1984;74: 185-89. 68. Nishioka GJ, Cook PR, Davis WE, et al. Functional endoscopic sinus surgery in patients with chronic sinusitis and asthma. Otolaryngol Head Neck Surg. 1994;110:494-500. 69. Park AH, Lau J, Stankiewicz J, et al. The role of functional endoscopic sinus surgery in asthmatic patients. J Otolaryngol. 1998;27:275-80. www.amcp.org Vol. 10, No. 4 July/August 2004 JMCP Journal of Managed Care Pharmacy 317  . . .
. . .  V, Passalacqua G, Bagnasco M, Canonica GW. Specific allergen challenge induces ICAM-1 expression on nasal epithelial cells in allergic subjects. Am J Respir Crit Care Med. 1994;150(6 pt 1):1653-59. 32. Busse WW, Calhoun WF, Sedgwick JD. Mechanism of airway inflamma- tion in asthma. Am Rev Respir Dis. 1993;147(6 pt 2):S20-S24. 33. Foresi A, Pelucchi A, Gherson G, Mastropasqua B, Chiapparino A, Testi R. Once-daily intranasal fluticasone propionate (200 micrograms) reduces nasal symptoms and inflammation but also attenuates the increase in bronchial responsiveness during the pollen season in allergic rhinitis . J Allergy Clin Immunol. 1996;98:274-82. 34. Djukanovic R, Wilson JW, Britten KM, et al. Effect of an inhaled cortico- steroid on airway inflammation and symptoms in asthma. Am Rev Respir Dis. 1992;145:669-74. 35. Sedgwick JB, Calhoun WJ, Gleich GJ, et al. Immediate and late airway response of allergic rhinitis . . .
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