Staph infection in nose: Symptoms, treatment, and diagnosis

A staphylococcus, or staph, infection is an infection caused by the bacteria Staphylococcus aureus.

Many people carry Staphylococcus aureus (S.aureus) on their skin or within their nose.

Here we look at the various causes and symptoms of a staph infection in the nose. We also outline the available treatment options for a nasal staph infection, as well as some tips for prevention.

Share on PinterestExcessively blowing or rubbing the nose is a possible cause of a staph infection in the nose.

The bacteria S. aureus cause staph infection.

Between 20–80% of humans carry S. aureus within their nasal passages. Most of the time, the bacteria do not cause any harm. However, if the skin of the nose becomes damaged, the bacteria can enter the wound and cause an infection.

Damage to the surface of the skin may trigger a mild to a moderate staph infection. Damage to the deeper layers of the skin may trigger a severe or even life-threatening staph infection.

Staph bacteria are contagious and can spread to other people through:

• skin-to-skin contact
• sharing personal items, such as toothbrushes, razors, or washcloths
• coughing or sneezing, although these types of transmission are less common

A staph infection in the nose can occur as a result of a scratch, sore, or other types of damage to the skin of the nose.

Some potential causes of a nasal staph infection include:

• nose picking
• excessively blowing or rubbing the nose
• plucking or tweezing nasal hairs

A person who has a nasal staph infection may develop the following symptoms:

• redness and swelling of the nose
• crusting around the nostrils
• boils inside one or both nostrils
• facial swelling
• pain
• fever

In some cases, a staph infection may resolve by itself. In other cases, a person will require treatment to clear the infection and prevent further complications.

Some people may succeed in treating minor nasal infections at home. People can soothe sores and crusting by holding a clean, warm, damp cloth onto affected areas. It is important to wash the cloth afterward to avoid spreading the bacteria.

Some people may develop pus-filled boils inside the nostrils. A doctor will need to drain the boil in order to treat the infection and promote wound healing. This procedure typically involves the use of a local anesthetic.

If a nasal staph infection does not clear up by itself, a person may need to take oral antibiotics or apply topical antimicrobial treatments.

Without treatment, staph infections may recur. This is because S.aureus remains inside the nasal passages.

Prescription antibiotic treatments can reduce numbers of staph bacteria, thereby helping to prevent the staph infection from recurring.

Researchers have been investigating the best treatment to prevent recurrent staph infections. According to a 2015 review, topical antimicrobial medications may be more effective than oral antibiotics. This is because S. aureus may have a lower resistance to topical treatments.

Practicing good personal hygiene may also help to reduce the risk of repeat infections.

If a staph infection enters the bloodstream, it can cause serious complications. We list some potential complications below.

Facial cellulitis

Facial cellulitis is a bacterial infection affecting the deeper layers of the skin. Without treatment, the condition can be life-threatening.

Symptoms of facial cellulitis include:

• tenderness and pain in the face
• rash
• skin redness
• lockjaw
• a fever
• chills
• loss of appetite

Cavernous sinus thrombosis

A cavernous sinus thrombosis (CST) is a blood clot that forms in the cavernous sinuses. This is the hollow space between the brain and the eye sockets.

A CST can develop when an infection in the face or skull spreads to the cavernous sinuses. Although rare, the condition can be life-threatening.

Symptoms of a CST include:

• a fever
• a severe headache
• swelling around the eyes
• a weakness of the eye muscles, resulting in drooping eyelids, or double vision
• severe eye pain

Endocarditis

An infection can sometimes spread to the inner lining of the heart chambers and valves. The medical term for this is endocarditis.

Symptoms of endocarditis include:

• a fever
• chills
• fatigue
• aching muscles and joints
• difficulty breathing
• nausea and vomiting
• blood in the urine

Pneumonia

Pneumonia is the medical term for inflammation of one or both lungs. It typically occurs as a result of infection.

In pneumonia, the tiny air sacs, or alveoli, within the lungs fill with fluid or pus. This makes it difficult for a person to breathe.

Some common symptoms of pneumonia include:

• rapid or shallow breathing
• breathlessness, even when resting
• chest pain that worsens when breathing or coughing
• rapid heartbeat
• a fever
• chills
• feeling generally unwell
• loss of appetite

Sepsis

Sepsis is a potentially life-threatening condition in which the body’s immune system overreacts to an infection. This overreaction leads to a toxic build-up of chemicals within the blood.

Symptoms of sepsis include:

• rapid breathing
• increased heart rate
• a fever
• chills
• feeling confused or disorientated

Toxic shock syndrome

Toxic shock syndrome (TSS) is a rare condition in which staph bacteria release dangerous levels of toxins into the bloodstream. TSS can be life-threatening.

The symptoms of TSS come on suddenly and worsen rapidly. They include:

• a fever
• flu-like symptoms, such as a headache, body aches, and a sore throat
• nausea and vomiting
• diarrhea
• a widespread skin rash that appears similar to sunburn
• a bright red coloring of the lips, tongue, and eye-whites
• difficulty breathing
• fainting
• confusion

There are steps a person can take to reduce their risk of developing or spreading a staph infection of the nose or skin. These include:

• regularly washing hands with soap and clean water
• showering or bathing daily to keep skin clean
• covering any cuts or wounds with sterile bandaids or dressings
• avoiding sharing personal items, such as toothbrushes, razors, and washcloths
• covering the mouth and nose when coughing or sneezing
• disposing of tissues after blowing the nose
• avoiding picking the nose
• using only sterile equipment to pluck or tweeze nasal hair, or avoiding these practices altogether

Some staph infections may resolve by themselves, while others may require treatment.

People should see a doctor if the staph infection:

• is severe
• lasts longer than a week, or keeps coming back
• is getting worse, or spreading to other parts of the face
• causes a skin rash or redness
• causes fever or chills
• causes breathing difficulty, or a change in heart rate

Anyone who has a weakened immune system should see a doctor at the first sign of a staph infection. This includes people who:

• are elderly
• have an autoimmune disease
• are receiving chemotherapy
• have received an organ transplant

Staph bacteria commonly live inside the nose and are usually harmless. However, if the skin of the nose becomes damaged, the bacteria can enter the wound and cause infection.

A person who has a nasal staph infection may develop redness, sores, or crusting around the nostrils. A person may need antibiotics or topical antimicrobial medications to treat the infection.

People should seek treatment if their infection is severe or persistent or accompanied by other symptoms. People who have a weakened immune system should seek treatment as soon as possible to reduce the risk of complications.

Staph infection in nose: Symptoms, treatment, and diagnosis

A staphylococcus, or staph, infection is an infection caused by the bacteria Staphylococcus aureus.

Many people carry Staphylococcus aureus (S.aureus) on their skin or within their nose.

Here we look at the various causes and symptoms of a staph infection in the nose. We also outline the available treatment options for a nasal staph infection, as well as some tips for prevention.

Share on PinterestExcessively blowing or rubbing the nose is a possible cause of a staph infection in the nose.

The bacteria S. aureus cause staph infection.

Between 20–80% of humans carry S. aureus within their nasal passages. Most of the time, the bacteria do not cause any harm. However, if the skin of the nose becomes damaged, the bacteria can enter the wound and cause an infection.

Damage to the surface of the skin may trigger a mild to a moderate staph infection. Damage to the deeper layers of the skin may trigger a severe or even life-threatening staph infection.

Staph bacteria are contagious and can spread to other people through:

• skin-to-skin contact
• sharing personal items, such as toothbrushes, razors, or washcloths
• coughing or sneezing, although these types of transmission are less common

A staph infection in the nose can occur as a result of a scratch, sore, or other types of damage to the skin of the nose.

Some potential causes of a nasal staph infection include:

• nose picking
• excessively blowing or rubbing the nose
• plucking or tweezing nasal hairs

A person who has a nasal staph infection may develop the following symptoms:

• redness and swelling of the nose
• crusting around the nostrils
• boils inside one or both nostrils
• facial swelling
• pain
• fever

In some cases, a staph infection may resolve by itself. In other cases, a person will require treatment to clear the infection and prevent further complications.

Some people may succeed in treating minor nasal infections at home. People can soothe sores and crusting by holding a clean, warm, damp cloth onto affected areas. It is important to wash the cloth afterward to avoid spreading the bacteria.

Some people may develop pus-filled boils inside the nostrils. A doctor will need to drain the boil in order to treat the infection and promote wound healing. This procedure typically involves the use of a local anesthetic.

If a nasal staph infection does not clear up by itself, a person may need to take oral antibiotics or apply topical antimicrobial treatments.

Without treatment, staph infections may recur. This is because S.aureus remains inside the nasal passages.

Prescription antibiotic treatments can reduce numbers of staph bacteria, thereby helping to prevent the staph infection from recurring.

Researchers have been investigating the best treatment to prevent recurrent staph infections. According to a 2015 review, topical antimicrobial medications may be more effective than oral antibiotics. This is because S. aureus may have a lower resistance to topical treatments.

Practicing good personal hygiene may also help to reduce the risk of repeat infections.

If a staph infection enters the bloodstream, it can cause serious complications. We list some potential complications below.

Facial cellulitis

Facial cellulitis is a bacterial infection affecting the deeper layers of the skin. Without treatment, the condition can be life-threatening.

Symptoms of facial cellulitis include:

• tenderness and pain in the face
• rash
• skin redness
• lockjaw
• a fever
• chills
• loss of appetite

Cavernous sinus thrombosis

A cavernous sinus thrombosis (CST) is a blood clot that forms in the cavernous sinuses. This is the hollow space between the brain and the eye sockets.

A CST can develop when an infection in the face or skull spreads to the cavernous sinuses. Although rare, the condition can be life-threatening.

Symptoms of a CST include:

• a fever
• a severe headache
• swelling around the eyes
• a weakness of the eye muscles, resulting in drooping eyelids, or double vision
• severe eye pain

Endocarditis

An infection can sometimes spread to the inner lining of the heart chambers and valves. The medical term for this is endocarditis.

Symptoms of endocarditis include:

• a fever
• chills
• fatigue
• aching muscles and joints
• difficulty breathing
• nausea and vomiting
• blood in the urine

Pneumonia

Pneumonia is the medical term for inflammation of one or both lungs. It typically occurs as a result of infection.

In pneumonia, the tiny air sacs, or alveoli, within the lungs fill with fluid or pus. This makes it difficult for a person to breathe.

Some common symptoms of pneumonia include:

• rapid or shallow breathing
• breathlessness, even when resting
• chest pain that worsens when breathing or coughing
• rapid heartbeat
• a fever
• chills
• feeling generally unwell
• loss of appetite

Sepsis

Sepsis is a potentially life-threatening condition in which the body’s immune system overreacts to an infection. This overreaction leads to a toxic build-up of chemicals within the blood.

Symptoms of sepsis include:

• rapid breathing
• increased heart rate
• a fever
• chills
• feeling confused or disorientated

Toxic shock syndrome

Toxic shock syndrome (TSS) is a rare condition in which staph bacteria release dangerous levels of toxins into the bloodstream. TSS can be life-threatening.

The symptoms of TSS come on suddenly and worsen rapidly. They include:

• a fever
• flu-like symptoms, such as a headache, body aches, and a sore throat
• nausea and vomiting
• diarrhea
• a widespread skin rash that appears similar to sunburn
• a bright red coloring of the lips, tongue, and eye-whites
• difficulty breathing
• fainting
• confusion

There are steps a person can take to reduce their risk of developing or spreading a staph infection of the nose or skin. These include:

• regularly washing hands with soap and clean water
• showering or bathing daily to keep skin clean
• covering any cuts or wounds with sterile bandaids or dressings
• avoiding sharing personal items, such as toothbrushes, razors, and washcloths
• covering the mouth and nose when coughing or sneezing
• disposing of tissues after blowing the nose
• avoiding picking the nose
• using only sterile equipment to pluck or tweeze nasal hair, or avoiding these practices altogether

Some staph infections may resolve by themselves, while others may require treatment.

People should see a doctor if the staph infection:

• is severe
• lasts longer than a week, or keeps coming back
• is getting worse, or spreading to other parts of the face
• causes a skin rash or redness
• causes fever or chills
• causes breathing difficulty, or a change in heart rate

Anyone who has a weakened immune system should see a doctor at the first sign of a staph infection. This includes people who:

• are elderly
• have an autoimmune disease
• are receiving chemotherapy
• have received an organ transplant

Staph bacteria commonly live inside the nose and are usually harmless. However, if the skin of the nose becomes damaged, the bacteria can enter the wound and cause infection.

A person who has a nasal staph infection may develop redness, sores, or crusting around the nostrils. A person may need antibiotics or topical antimicrobial medications to treat the infection.

People should seek treatment if their infection is severe or persistent or accompanied by other symptoms. People who have a weakened immune system should seek treatment as soon as possible to reduce the risk of complications.

Aspirin asthma and leukotriene antagonists | Princely N.P.

B bronchial asthma (BA) is a chronic inflammatory disease of the respiratory tract, in which many cells take part: mast cells, eosinophils, T-lymphocytes. In susceptible individuals, this inflammation leads to repeated episodes of wheezing, shortness of breath, chest tightness, and coughing, especially at night and/or early morning. These symptoms are usually accompanied by widespread but variable obstruction of the bronchial tree, which is partially or completely reversible spontaneously or under the influence of treatment.

The term “ aspirin asthma ” ( AA ) is used to denote a clinical and pathogenetic variant, when one of the bronchoconstrictor factors in a patient is non-steroidal anti-inflammatory drugs (NSAIDs) , including acetylsalicylic acid. Aspirin asthma usually consists of a triad of symptoms: polypous rhinosinusitis, asthma attacks, and intolerance to NSAIDs. Often, aspirin asthma is combined with atopic asthma, but it can also be observed as an isolated form of the disease.

Epidemiology

There is no convincing evidence of hereditary predisposition to AA. However, research in this area is being carried out, because. there are data on several families with a combination of asthma and aspirin intolerance. AA occurs between the ages of 30 and 50, and is more common in women. The frequency of occurrence among all patients with BA is 9-22%, according to the latest data – up to 40%.

Background

Aspirin introduced into clinical practice in 1899 as an analgesic and antipyretic drug, and already in 1903 Franke (Germany) described an allergic reaction in the form of laryngospasm and shock to aspirin. In 1905, Barnett reported 2 cases of difficulty breathing while taking aspirin. In 1919, Francis identified a relationship between polyposis rhinitis and hypersensitivity to aspirin. In 1922, Widal first established the relationship between aspirin intolerance, polypous rhinitis and bronchial asthma. In 1968, Samter and Beers described this symptom complex again, which they called the “aspirin triad”. Since that time, much has been learned about the epidemiology, clinical manifestations, and pathophysiology of intolerance to aspirin and other NSAIDs in patients with asthma. The key question is: why is NSAID intolerance observed only in some patients with asthma? The discovery of cystenyl-leukotrienes and their involvement in the pathogenesis of bronchial asthma largely explains the pathogenesis of the aspirin triad.

Clinical picture

Aspirin asthma is often characterized by a severe persistent course. Patients with AA quite often end up in intensive care units, according to a number of authors, more often than patients with other clinical and pathogenetic variants of bronchial asthma. Of particular note is the course of rhinosinusitis in patients with AA. Most often, AA debuts with prolonged rhinitis, which in 20-25% of patients gradually turns into polypous rhinosinusopathy. Manifestations of aspirin rhinosinusopathy: rhinorrhea, nasal congestion, lack of odor perception, pain in the projection of the paranasal sinuses, headaches. About half of patients with polyposis rhinosinusitis eventually begin to react with choking to taking NSAIDs. Often, the first asthma attacks in this category of patients occur after surgical interventions, such as polypectomy, radical operations on the paranasal sinuses, etc. In some cases, polyposis also affects other mucous membranes – the stomach, the genitourinary system. Sometimes the first asthma attack is preceded by years of continuously recurrent chronic rhinitis, in which it is not possible to detect exoallergens. As a rule, nasal symptoms are severe and difficult to treat. Topical and sometimes systemic glucocorticosteroids are commonly used. But their therapy is often not effective enough, and patients regularly undergo surgical treatment.

Patients with AA are intolerant of aspirin and other NSAIDs. This intolerance manifests itself in the form of facial flushing, asthma attacks, coughing, rhinitis and conjunctivitis, urticaria, Quincke’s edema, fever, diarrhea, abdominal pain, accompanied by nausea and vomiting. The most severe manifestations of the reaction to aspirin and other NSAIDs are status asthmaticus, respiratory arrest, loss of consciousness and shock. It should be noted that the tolerability of various NSAIDs is different, which depends on the anticyclooxygenase activity of the drug and its dose, as well as on the sensitivity of the patient. Drugs with high cyclooxygenase activity include salicylates (acetylsalicylic acid – aspirin, salicylic acid), polycyclic acids (indomethacin, tolmetin), unsaturated fatty acids (diclofenac, ibuprofen, ketoprofen, thiaprofenic acid), enolic acids (piroxicam).

Paracetamol , widely used in clinical practice, is of particular interest. As early as 1919, Francis noted that phenacetin did not cause adverse reactions in individuals with aspirin intolerance. According to the mechanism of action, phenacetin is similar to paracetamol, however, phenacetin is currently used in clinical practice extremely rarely due to severe side effects. Paracetamol is an analgesic and antipyretic with antipyretic, analgesic and weak anti-inflammatory effects. Paracetamol is well tolerated and does not cause bronchospastic reactions. However, when starting therapy with paracetamol in patients with AA, no more than 500 mg should be prescribed and the patient should be monitored for 2-3 hours, since this drug can cause an asthma attack in 5% of patients.

Pathogenesis

Cells involved in inflammation in the airways produce a variety of mediators that directly affect bronchial smooth muscle, blood vessels, and mucus-secreting cells, as well as send signals to other cells, thereby attracting and activating them. Among the various mediators that cause contraction of the smooth muscles of the bronchi, the most important are cysteine ​​ leukotrienes . These substances can also cause bronchial edema and hyperreactivity, and alter mucus secretion.

The so-called slow-reacting substance of anaphylaxis (MPC-A) was discovered by Felberg and Kellaway in 1938, when these investigators injected cobra venom into the lungs of guinea pigs and showed that bronchospasm was observed, not associated with the action of histamine, which occurred more slowly and lasted longer. Although Brockehurst et al. had already concluded in the 1960s that MPC-A was an extremely important mediator of allergy, Samuelsson and his colleagues, who established the structure of MPC-A, had to wait for better analytical methods to decipher it. Since the discovery that MPC-A is in fact leukotrienes, significant research efforts have been made to understand the biological properties of leukotrienes and to develop drugs that antagonize or inhibit their synthesis.

Biochemistry of leukotrienes

Leukotrienes (LT) are synthesized from arachidonic acid, which is released upon immunological or non-immunological stimulation of various cells involved in inflammation. Arachidonic acid can undergo further metabolic transformations both with the help of the cyclooxygenase system with the formation of prostaglandins and thromboxanes, and with the help of the 5-lipoxygenase enzyme system with the formation of leukotrienes (Fig. 1). 5-lipoxygenase requires a membrane-bound protein called 5-lipoxygenase-activating protein to function. It appears to be the contact protein for arachidonic acid. Once 5-lipoxygenase converts arachidonic acid into leukotrienes, it is degraded and inactivated. A natural intermediate product during the functioning of the 5-lipoxygenase enzyme system is leukotriene A ₄ (LTA ₄ ) – an unstable epoxide, which then, when combined with water, can be converted non-enzymatically into dihydroxy acid leukotriene B4 (LTV ₄ ) or, when combined with glutathione, into cysteine ​​leukotriene C _{4 900 59 (LTS 4 ). LTS 4 is further converted to LTD 4 with the help of g-glutamyltransferase and then, with the help of dipeptidases, to LTE 4 , which undergoes further metabolism. A person has a small but constant part of LTE 4 is excreted unchanged in the urine, making it possible to control the production of leukotrienes in AD and other diseases.}

Different cells synthesize LTV ₄ and cysteine ​​leukotrienes in different ratios. Eosinophils, basophils, mast cells and alveolar macrophages are capable of synthesizing LTS ₄ . Neutrophils synthesize mainly LTV ₄ .

Biological properties of leukotrienes

The receptors for LTV ₄ and for cysteine ​​leukotrienes are different. The main actions of LTV ₄ appear to be the recruitment and activation of cells involved in inflammation, primarily neutrophils and eosinophils. LTV ₄ is believed to play an important role in the development of suppurative inflammation, rheumatoid arthritis and other inflammatory diseases. However, its role in the pathogenesis of bronchial asthma is questionable and remains unclear. It has been shown that in AD antagonists of receptors to LTV ₄ have no effect on the early and delayed phases of the response to antigen challenge.

Emphasizing the role of cystenyl-leukotrienes in the pathogenesis of AA, it should be noted an increased content of leukotrienes E ₄ (approximately 3-6 times) in urine and C ₄ in nasal secretion in comparison with other variants of bronchial asthma. Aspirin provocation sharply increases the amount of leukotrienes E ₄ and C ₄ in urine, nasal secretion and bronchial lavage.

The platelet theory of the development of AA is also of great interest. It was found that the platelets of AA patients, in contrast to the platelets of healthy individuals, are activated in vitro under the action of NSAIDs, which is manifested by cell degranulation with the release of cytotoxic and pro-inflammatory mediators. Other peripheral blood cells are not activated by NSAIDs in vitro . As is known, NSAID-induced blockade of cyclooxygenase leads to inhibition of the production of prostaglandin H ₂ . The authors of the platelet theory suggest that a decrease in the level of this prostaglandin plays an important role in the activation of platelets in patients with AA.

In the vast majority of studies, the participation of the reagin mechanism in the development of aspirin suffocation was not revealed. There are only a few reports of the detection of specific immunoglobulins E to aspirin derivatives.

Diagnostics

Important in the diagnosis of aspirin asthma are history data about the patient’s reaction to taking painkillers or antipyretics. In some patients, there may be clear indications of the development of an asthma attack after the use of NSAIDs. The absence of indications of intolerance to NSAIDs in a number of patients with AA, as a rule, is due to the following reasons: a relatively low degree of hypersensitivity to drugs with anticyclooxygenase action; concomitant use of medications that neutralize the bronchoconstrictor effect of NSAIDs (for example, antihistamines, theophyllines, sympathomimetics), delayed patient response to NSAIDs; rare use of NSAIDs. Choking attacks in patients with AA who do not take NSAIDs may be associated with the consumption of natural salicylates, as well as foods preserved with salicylates. It should be noted that a significant proportion of patients are not aware that various NSAIDs are part of such frequently used combined drugs as citramon, pentalgin, sedalgin, baralgin, etc.

It is important to ask the asthmatic patient about the effectiveness of theofedrine for the relief of an asthma attack. Patients with AA usually indicate the inefficiency of theofedrine, or note its two-stage action: at first, bronchospasm decreases somewhat, and then increases again due to the presence of amidopyrine and phenacetin in theofedrine.

The intensity of the reaction to NSAIDs depends on the degree of sensitivity of the patient to the drug, and it also closely correlates with the anticyclooxygenase activity of this drug. Indomethacin has the highest activity against cyclooxygenase among NSAIDs. The stronger the anticyclooxygenase action of NSAIDs, the more intense the symptoms of intolerance to this group of drugs. The intensity of the reaction also correlates with the dose of the medication taken. An important role is played by the method of application of NSAIDs. With inhalation, intravenous or intramuscular routes of administration, the intensity of the reaction is usually maximum.

Thus, in the diagnosis of aspirin bronchial asthma, an important role is given to the collection of anamnesis and clinical manifestations of the disease.

Provocation tests in vivo or alternatively in vitro tests can currently be used to confirm the diagnosis of aspirin asthma. When performing a provocative test in vivo , either oral aspirin intake or inhalation in increasing concentrations of water-soluble aspirin – lysine-aspirin (aspizol) is used, followed by monitoring of bronchial patency. Due to the possibility of developing an asthma attack, this test can only be performed by a specialist. It is necessary to have equipment and trained personnel ready to provide emergency assistance with the development of bronchospasm. The indication for a provocative test with aspirin is the need to clarify the clinical and pathogenetic variant of asthma. Patients with an FEV of ₁ not less than 65-70% of the proper values. In addition to low respiratory function, a contraindication to provocative tests is also the need for frequent use of sympathomimetics, dementia, pregnancy, and severe bleeding. Antihistamines reduce the patient’s sensitivity to aspirin, so they are canceled at least 48 hours before the start of the test. Sympathomimetics and theophylline preparations are canceled depending on their pharmacokinetic properties, for example, salmeterol should be canceled at least 24 hours before the start of the test.

Currently, laboratory diagnostics of aspirin bronchial asthma is being developed, associated with the determination of leukotrienes E ₄ in urine and C ₄ in nasal lavage. It should be noted that when conducting provocative tests with lysine-aspirin in the group of patients with AA, the content of leukotriene E ₄ in urine and C ₄ in nasal lavage sharply increases. Apparently, certain standards in the diagnosis of this variant of AD will be recommended in the near future.

Treatment

Currently, in the treatment of asthma, including aspirin, the main role is given to long-term use of anti-asthmatic anti-inflammatory drugs. For the selection of adequate anti-inflammatory therapy, it is important to determine the severity of the course of bronchial asthma. No test will allow us to accurately classify the severity of asthma. However, a cumulative assessment of symptoms and indicators of respiratory function gives a characterization of the severity of the disease. It has been shown that the assessment of the course of asthma, based on the clinical manifestations of the disease, is associated with indicators of the degree of airway inflammation.

Both the level of obstruction and the degree of its reversibility allow asthma to be subdivided according to severity into intermittent, mild persistent (chronic), moderate (moderate) and severe. In the treatment of asthma, a stepwise approach is currently used, in which the intensity of therapy increases as the severity of asthma increases. The most commonly used drugs outside of asthma exacerbations are inhaled corticosteroids, the dose of which depends on the severity of asthma, nedocromil and sodium cromoglycate, long-acting theophyllines and long-acting sympathomimetics.

Patients with AA usually require high maintenance doses of inhaled corticosteroids and long-term treatment of nasal symptoms with topical steroids. Often it is necessary to resort to the appointment of systemic steroids. Therefore, various pathogenetic approaches to the therapy of AA are being developed.

One of the pathogenetic methods of treatment of aspirin asthma is desensitization with aspirin . The method is based on the phenomenon of the development of tolerance of a patient with AA to repeated exposure to NSAIDs in the period of 24-72 hours after suffocation caused by NSAIDs. Stevenson showed that aspirin desensitization was able to control the symptoms of rhinosinusitis and asthma. Desensitization with aspirin is also carried out by patients, if necessary, to prescribe NSAIDs for other diseases (CHD, rheumatic diseases, etc.). Desensitization is carried out according to various schemes, which are selected individually. Desensitization is carried out only in a hospital by a doctor who owns this technique. Start with a dose of 5-10 mg and reach a dose of 650 mg and above. Maintenance doses – 325-650 mg per day. A contraindication to aspirin desensitization is exacerbation of bronchial asthma, bleeding, peptic ulcer of the stomach and duodenum, severe liver and kidney disease, pregnancy. Recent studies have shown that the mechanism of desensitization is associated with the formation of insensitivity of airway receptors to the effects of leukotrienes.

Currently, a new class of anti-inflammatory anti-asthma drugs has appeared – leukotriene receptor antagonists . The results of studies indicate that these drugs quickly eliminate the basal tone of the airways created by leukotrienes due to chronic activation of the 5-lipoxygenase enzyme system. One of the representatives of this group is a highly selective and highly active drug zafirlukast (acolate). Zafirlukast, when administered orally, leads to a significant increase in FEV ₁ in patients with impaired lung function who have previously used effective anti-asthma drugs, including inhaled corticosteroids.

Especially widespread use of leukotriene antagonists was obtained in aspirin bronchial asthma, since in the pathogenesis of this form of asthma there is an increased activation of the 5-lipoxygenase system and an increased sensitivity of receptors to leukotrienes. Leukotriene antagonists in these patients improve airway function and block the effect of inhaled lysine-aspirin. Thus, leukotriene antagonists have proved to be particularly effective in this group of patients, whose treatment is often difficult.

In the conducted studies, the addition of zafirlukast to the treatment of aspirin BA causes an increase in FEV ₁ , indicators of peak expiratory flow in the morning and evening hours, and a decrease in nocturnal asthma attacks compared with placebo. Zafirlukast is effective both in monotherapy and in combination with other drugs used as a maintenance treatment in chronic asthma. Studies have also shown a good effect of leukotriene antagonists in combination with inhaled and oral steroids. Zafirlukast contributes to maintaining a stable clinical state and has an additive clinical effect, allowing a reduction in the amount of steroid therapy. Thus, at present, we can say that a class of drugs has appeared that affects the pathogenetic link of aspirin bronchial asthma and has a pronounced clinical effect.

It should be noted again that if it is necessary to prescribe drugs to reduce temperature or pain relief, paracetamol should be prescribed at an initial dose of 0. 5 g per day. During therapy with paracetamol in patients with AA, the patient’s condition should be monitored (preferably with a peak flow meter) for 2–3 hours, since this drug can cause an asthma attack in 5% of patients. If well tolerated, the dose can be increased if necessary.

what it is, principle and validity period, when vaccinations will start, contraindications, side effects Scientists in different countries worked on this form of vaccine, but it was in Russia that the nasal vaccine not only passed several stages of clinical trials on humans, but also became available to protect against coronavirus infection.

The nasal vaccine against coronavirus was developed in the same place as Sputnik V – at the National Research Center for Epidemiology and Microbiology. N.F. Gamaleya. In October 2021, the development of the drug was completed, after which, with the permission of the Ministry of Health, scientists began phases 1 and 2 of clinical trials. According to the creators of the vaccine, this is the same “Sputnik V” (two-component vaccine): the difference is only in the method of administration.

The unusual form of the vaccine is not new to Russia. For example, one of the Russian flu vaccines, Ultravak, is also nasal.

How the coronavirus nasal vaccine works

The nasal vaccine is basically a spray. The drug is in a syringe, but not a needle is put on it, but a special nozzle with a sprayer. If you press the syringe plunger in front of your nose and inhale deeply, the liquid in the form of tiny droplets will settle in the nasal cavity. Secretory antibodies are formed on the mucous membrane, which will neutralize the virus that tries to enter the body by airborne droplets.

The nasal vaccine, like its predecessor Sputnik V, does not contain the coronavirus itself or its particles. But there are adenoviral vectors with a modified genome, with the help of which antibodies are produced in the body.

Like Sputnik V, the nasal vaccine has two components and is given three weeks apart.

What is the difference between a nasal vaccine and a regular one

The main difference between vaccines is that the injection creates a certain level of protective antibodies in the blood. And the nasal vaccine forms a reliable barrier to the penetration of the coronavirus – it does not allow it to penetrate the nasal mucosa.

The director of the Center named after V.I. Gamalei Alexander Gintsburg ² .

– A person who has been vaccinated intranasally will never be a carrier of the coronavirus. If a person has been vaccinated by injection, he again will not get sick, but he can carry the virus on his mucous membrane. And if he gets into the environment of unvaccinated people, where he coughs or sneezes, he will excrete the virus. And others can get sick, – emphasizes the scientist.

The same opinion is shared by American scientists who are developing their own nasal vaccine.

– Intramuscular injection does not guarantee the appearance of antibodies in the nasal passages. This makes it more likely that vaccinated people can still become infected and spread the virus even if they don’t have symptoms of the disease. It is believed that nasal (nasal) vaccines can block SARS-CoV-2 both in the nasal passages and in the bloodstream ³ , – experts from the National Institutes of Health in Maryland (USA) note.

And the nasal vaccine is a real lifesaver for people who are terrified of injections.

Coronavirus nasal vaccine contraindications

Since the nasal vaccine is still the familiar Sputnik, it has the same contraindications:

• hypersensitivity to vaccine components or vaccines containing similar components;
• history of allergic reactions;
• exacerbation of chronic diseases;
• acute communicable and non-communicable diseases;
• under 18 years of age.

Pregnant women (starting at 22 weeks gestation) and breastfeeding mothers may be vaccinated if the benefit of vaccination outweighs the potential risk to the baby.

By the way, it is worth noting that a deviated nasal septum or a common cold can affect the effectiveness of vaccination.

Nasal coronavirus vaccine side effects

In the first days after vaccination, a person may complain of headache, general malaise, swelling and redness of the nasal mucosa, discomfort in the nasopharynx.

Chief Researcher of the Center. N.F. Gamaleya Anatoly Altshtein believes that there are no grounds to consider the nasal vaccine dangerous.

– The virus contained in the vaccine is able to infect a cell, but does not produce offspring. And the vaccine after the introduction into the brain will not work. There is simply nothing to go, – the scientist notes ⁴ .

Can the nasal vaccine replace the usual one? Therefore, one does not exclude the other, but supports.

– First you need to be vaccinated intramuscularly with Sputnik V. And since the virus in the human body enters through the nasopharynx, the intranasal vaccine creates local immunity when inhaled, and the pathogen will encounter antibodies. The vaccine should not be used at your own discretion! Only a doctor can give a recommendation on the choice and find out under what conditions this or that vaccine is suitable, ”said the director of the center to them. N.F. Gamaleya.

The epidemiologist, academician of the Russian Academy of Medical Sciences Gennady Onishchenko also notes the advantages of the nasal vaccine.

– The nasal vaccine is faster and more effective than the regular vaccine. The nasal vaccine settles on the respiratory tract and “meets” the virus as if at the entrance. This is very important from the point of view of the severity of the course of the disease in case of infection and the burden on the body ⁶ , Gennady Onishchenko emphasizes.

Doctor’s review of nasal coronavirus vaccine

Opinion toxicologist Mikhail Kutushov , nasal vaccine is a more promising tool.

– This form of vaccination helps to avoid the risks that come with an injection. Therefore, the nasal form of the vaccine is a more natural way to protect the body from serious and dangerous diseases, including those that are dangerous and have consequences, our expert says.

Sanitary doctor, coronavirus expert Nikolai Dubinin says that nasal vaccines are a modern method of administration and an effective way of delivering antigens precisely to those areas that are responsible for the development of local immunity. The manufacturer claims that the general immunity is not worse. The nasal vaccine is optimal for revaccination. The main thing to remember is that you can’t blow your nose after vaccination! In a word, more vaccines are good and different – they will help create a more stable and strong immune response.

– It is important to remember that after intranasal administration of the vaccine, the patient must be under the supervision of medical professionals for at least 30 minutes. Within 2 hours, you should refrain from sneezing and blowing your nose, it is also necessary to exclude smoking, eating and drinking, the expert emphasizes.

Popular Questions and Answers

Toxicologist, Corresponding Member of the Russian Academy of Natural Sciences Mikhail Kutushov answers popular questions.

Are nasal vaccines a modern invention?

– No, they have been known for a long time. In Russia, the intranasal live influenza vaccine Ultravak has been produced since 1982. Similar nasal vaccines are available in the US and Europe.

Nasal coronavirus vaccines are currently being developed in laboratories around the world. Most of them are still at the stage of clinical trials.

Can the nasal vaccine be used for revaccination?

– Yes, you can. According to the director of the center Gamaleya Gunzburg, revaccination with a nasal vaccine can be carried out every six months. With regard to official recommendations, a group of experts decides on them.

Will there be other nasal vaccines against coronavirus in Russia?

– In February 2022, clinical trials of a nasal vaccine from the Generium company began. This vaccine is identical in composition of active substances to Sputnik V, intended for intramuscular injection.

Sources:

1. The Russian Ministry of Health has registered the world’s first nasal vaccine against COVID-19. Russian Ministry of Health. https://web.telegram.org/z/#-1512944688
2. “Dangerous virus. Second year”. “Russia 1”. December 6, 2021 https://smotrim.ru/brand/64900
3. Intranasal COVID-19 vaccine effective in animal studies. August 10, 2021. National Institutes of Health, Maryland. https://www.nih.gov/news-events/nih-research-matters/intranasal-covid-19-vaccine-effective-animal-studies
4. Virologist Chumakov warned about the possible dangers of the nasal vaccine.