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Allergic RhinitisEPONANCT02476929

Detection and Use of Nasal Nitrous Oxide and the Electronic Nose

A study testing Nasal nitrous oxide and Electronic nose in people with Allergic Rhinitis and Non-Allergic Rhinitis, run by Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau at 1 site in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Introduction: Rhinitis, sinonasal polyposis (SP) and asthma are diseases whose pathogenesis is based on inflammation. This will determine the presence of disease, its evolution and its treatment. Read more about this study

Who is it for?
Ages 18 to 70 yearsHealthy volunteers can take part
What is being tested?
Nasal nitrous oxide and Electronic nose
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
139 participants
Where
1 siteSpain
Study dates
Jan 2013to Dec 2016
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 70 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Sample of healthy individuals: Non-atopic individuals will be considered when skin prick skin tests with a standard battery of pneumoallergens are negative.
  • Individuals with nasal endoscopy not showing inflammatory lesions or anatomic abnormalities and who have an acoustic rhinometry compatible with normal values.
  • No sign of any acute infectious process during the four weeks preceding the study.
  • Signed informed consent.
  • Sample of individuals with Allergic Rhinitis: Atopic patients sensitized by skin prick testing and specific IgE determination to at least one perennial allergen.
  • Patients with symptoms compatible with persistent moderate or severe AR as rated by the ARIA 2008 guide of at least two years of evolution.
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  • No acute infectious process during the four weeks preceding the study.
  • Signed informed consent.
  • Sample of individuals with non-allergic rhinitis: The subject will be considered non-atopic when skin prick skin tests with a standard battery of pneumoallergens are negative.
  • Patients with symptoms of sneezing, watery rhinorrhea, nasal itching and/or nasal obstruction of at least two years evolution.
  • No acute infectious process during the four weeks preceding the study.
  • Signed informed consent.
  • Sample of individuals diagnosed with Sinunasal Polyposis and asthma: Patients diagnosed with asthma by clinical and lung function tests.
  • SP patients diagnosed by performing nasal endoscopy and CT of the paranasal sinuses.
  • Could be non-atopic patients or present any concomitant allergic diseases.
  • No acute infectious process during the four weeks preceding the study.
  • Signed informed consent.

Who cannot join

  • Smoker with history of more than 10 pack-years.
  • Pregnancy.
  • Having been treated with nasal or systemic drugs that may alter nasal resistance (vasoconstrictors, anticholinergics, corticosteroids, antihistamines, immunosuppressants and/or immunomodulators) during the past three weeks.
  • History of nasal surgery.
  • Having an autoimmune or inflammatory systemic disease.
  • Having an established diagnosis of intrinsic or extrinsic asthma (except polyposis group).
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  • Individuals with pathological nasal endoscopy.
  • Suffering from a neoplastic disease.
  • Having been treated with nasal or systemic drugs that may alter nasal resistance (vasoconstrictors, anticholinergics, corticosteroids, antihistamines, immunosuppressants and/or immunomodulators) during the past three weeks.

Trial locations and contacts

1 site in 1 country.

Spain1 site
  • Lorena Soto-Retes

    Barcelona, 08025

Other trials in Spain

About this study

Official title: AssEssment and New Perspectives on Pathophysiogenesis, detectiOn and Use of NAsal Nitrous Oxide and the Electronic Nose (EPONA Project)

Introduction: Rhinitis, sinonasal polyposis (SP) and asthma are diseases whose pathogenesis is based on inflammation. This will determine the presence of disease, its evolution and its treatment. It is therefore very important to develop and validate methodologies that allow us to noninvasively detect inflammation of the airways. Thus, just as exhaled nitric oxide (FeNO) has been studied as an important non-invasive marker of inflammation of the lower airways, nasal nitric oxide (nNO) may be a good marker of nasal inflammation. Furthermore, the electronic nose is an electronic nanosensor device capable of detecting specific volatile organic compounds (VOCs) that can be used as a non-invasive biomarker of biochemical processes in different diseases whose pathophysiology is also based on inflammation.

Objective: To determine reference values of nNO and different patterns of VOCs in healthy individuals, individuals with allergic rhinitis (AR) and non-allergic rhinitis and individuals with SP and asthma.

Methodology: Prospective, controlled study. Four groups will be included: Healthy subjects, patients with AR, non-allergic rhinitis and patients with SP and asthma (n=252). Prick-test to pneumoallergens will be performed. Determination of FeNO, nNO, lung function tests, measurement of VOCs by the electronic nose and blood samples will be taken. Bilateral nasal endoscopy and sample collection using the technique of brushing of mucosa and the placement of filter papers, for the study of nasal cytology and mediators of inflammation.

Read the detailed description

Assessment of nasal and bronchial inflammation:

Rhinitis (allergic and non-allergic), SP and asthma are diseases that are characterized by processes whose pathogenesis is based on inflammation. Inflammation of the airways can be assessed directly or indirectly. The techniques for assessing inflammation directly can be divided into invasive techniques and non-invasive techniques.

Within invasive techniques we include those which require nasal or bronchial endoscopy such as biopsy. However, the applicability of these invasive methods has many limitations because they are not without risks and/or complications. They also require considerable experience to implement. It is therefore very important to develop and validate new methods that allow us to non-invasively detect inflammation of the upper and lower airways.

Nitrous oxide (NO): Is synthesized from the amino acid L-arginine by the action of the enzyme nitric oxide synthase (NOS). Three isoforms of this enzyme are known: nNOS or NOS1, which predominates in nervous tissue; iNOS, inducible NOS or NOS2, induced by an agent that activates the immune system; and eNOS, endothelial NOS or NOS3, constituent of the vascular endothelium. Since iNOS is found in different cells of the respiratory tract and is induced by various inflammatory cytokines, NO is considered to be an excellent marker for airway inflammation. Thus, just as exhaled nitric oxide (FeNO) is considered a good non-invasive marker of inflammation of the lower airways, nasal nitric oxide (nNO) potentially appears be a good marker of nasal inflammation.

Nasal nitric oxide (nNO): Some authors describe reference values for nNO up to one hundred times higher than those for FeNO. However, until now normal levels of nNO in different nasal diseases and in healthy individuals have not been established because the published results vary widely. Dotsch et al. in 1996 published a series of 67 healthy subjects in which they found mean nNO values in a healthy population of 96±47 ppb. A year later Ferguson studied 82 healthy patients and published mean normal values of nNO of 1197±361 ppb. Additional papers were published subsequently, but the results remained quite diverse.

As for the reference values in patients with rhinitis, data published so far are also contradictory. Some authors show that nNO is higher in patients diagnosed with rhinitis, especially in patients with AR. However, other studies have not observed differences in levels of nNO in patients diagnosed with rhinitis compared to the normal population.

The electronic nose: Is a new technique which is based on the detection of VOCs present in the gas phase of the human respiration and that can be detected by chromatography and mass spectrometry sensors. It consists of a device made up of several nanosensors that when exposed to volatile particles undergo specific changes in their electrical resistance, resulting in a pattern or profile of VOCs by logarithmic regression. These VOC patterns can be used as non-invasive biomarkers of several biochemical processes that occur in different diseases whose pathogenesis is based on inflammation. For example, in diseases of the airways they have been used successfully in comparing patterns of VOCs in patients with chronic obstructive pulmonary disease (COPD) and asthma. This technique's potential applicability in biomedicine is enormous.

In short, both measuring nNO and determining patterns of VOCs by the electronic nose are non-invasive methods that can help in the diagnosis and monitoring of certain respiratory diseases. However, in the case of nNO currently available studies show very different and conflicting results and in the case of the determination of VOCs by electronic nose there are very few papers published to date. It is therefore vital to design a study that allows us to clarify the potential utility of non-invasive markers of inflammation such as determination of nNO and determination of the different patterns of VOCs by electronic nose in healthy patients, in patients diagnosed with AR and non-allergic rhinitis and in patients with associated SP and asthma.

Working Hypothesis: Rhinitis, SP and asthma are prevalent diseases that cause considerable morbidity. Since the substrate of these diseases lies in inflammation, our group of investigators believe that the study of inflammation is one of the most interesting aspects for assessment and management of these diseases. Similarly to how measuring FeNO is being used as a good marker of bronchial inflammation, measuring nNO and determining patterns of VOCs by the electronic nose could also be two good non-invasive markers of upper and/or lower (in the case of VOCs) airway inflammation. However, although in recent years there have been some studies on the origin, function and utility of measuring nNO and the use of the electronic nose in respiratory disease, there are still many questions that remain in reference to these two techniques.

Being tested
Nasal nitrous oxide, Electronic nose
Keywords
Electronic nose, Nasal nitrous oxide, Allergic Rhinitis, Non-Allergic Rhinitis, Nasal polyps
Medical subject headings
Rhinitis, Allergic, Common Cold, Nasal Polyps

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Nasal nitrous oxideDevice

    Electrochemical device (NOVario Analizer FILT), to determine reference values of Nasal nitrous oxide.

  • Electronic noseDevice

    To determine reference values of different patterns of specific volatile organic compounds with the electronic nose (Cyranose 320®).

Study groups in NCT02476929
Study groupRoleWhat they receive
Nasal nitrous oxideActive comparatorMesurement of Nasal nitrous oxide in all groups: allergic rhinitis, non-allergic rhinitis, nasosinusal polyps and healthy group
Receives: Device: Nasal nitrous oxide
Electronic noseActive comparatorMeasurement with the Electronic nose in all groups: allergic rhinitis, non-allergic rhinitis, nasosinusal polyps and healthy group.
Receives: Device: Electronic nose

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Values of nNO measure as parts per billions (ppb)

    Measured: 12 months

  2. Values of the electronic nose measure as volatile organic compounts (VOCs)

    Measured: 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Jun 2015 (estimated)
  2. Study startJan 2013
  3. Primary completionJul 2016
  4. Study completionDec 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Basic science
Allocation
Non-randomised
Intervention model
Crossover
Masking
None (open label)
Enrolment
139 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02476929
Sponsor's protocol ID
IIBSP-ONA-2011-146
Acronym
EPONA
Status last verified
Feb 2020
First submitted
2 Mar 2015
Last updated
13 Feb 2020
Results posted
No
Data monitoring committee
No
Individual data sharing
Undecided

Publications

  • Dragonieri S, Schot R, Mertens BJ, Le Cessie S, Gauw SA, Spanevello A, Resta O, Willard NP, Vink TJ, Rabe KF, Bel EH, Sterk PJ. An electronic nose in the discrimination of patients with asthma and controls. J Allergy Clin Immunol. 2007 Oct;120(4):856-62. doi: 10.1016/j.jaci.2007.05.043. Epub 2007 Jul 20.

    PubMed 17658592
  • Silkoff PE, Robbins RA, Gaston B, Lundberg JO, Townley RG. Endogenous nitric oxide in allergic airway disease. J Allergy Clin Immunol. 2000 Mar;105(3):438-48. doi: 10.1067/mai.2000.104938.

    PubMed 10719291
  • Lundberg JO, Farkas-Szallasi T, Weitzberg E, Rinder J, Lidholm J, Anggaard A, Hokfelt T, Lundberg JM, Alving K. High nitric oxide production in human paranasal sinuses. Nat Med. 1995 Apr;1(4):370-3. doi: 10.1038/nm0495-370.

    PubMed 7585069
  • Dotsch J, Demirakca S, Terbrack HG, Huls G, Rascher W, Kuhl PG. Airway nitric oxide in asthmatic children and patients with cystic fibrosis. Eur Respir J. 1996 Dec;9(12):2537-40. doi: 10.1183/09031936.96.09122537.

    PubMed 8980966
  • Ferguson EA, Eccles R. Changes in nasal nitric oxide concentration associated with symptoms of common cold and treatment with a topical nasal decongestant. Acta Otolaryngol. 1997 Jul;117(4):614-7. doi: 10.3109/00016489709113447.

    PubMed 9288222
  • Kharitonov SA, Rajakulasingam K, O'Connor B, Durham SR, Barnes PJ. Nasal nitric oxide is increased in patients with asthma and allergic rhinitis and may be modulated by nasal glucocorticoids. J Allergy Clin Immunol. 1997 Jan;99(1 Pt 1):58-64. doi: 10.1016/s0091-6749(97)70301-4.

    PubMed 9003212
  • Arnal JF, Didier A, Rami J, M'Rini C, Charlet JP, Serrano E, Besombes JP. Nasal nitric oxide is increased in allergic rhinitis. Clin Exp Allergy. 1997 Apr;27(4):358-62.

    PubMed 9146927
  • Lewis NS. Comparisons between mammalian and artificial olfaction based on arrays of carbon black-polymer composite vapor detectors. Acc Chem Res. 2004 Sep;37(9):663-72. doi: 10.1021/ar030120m.

    PubMed 15379582
  • Fens N, Zwinderman AH, van der Schee MP, de Nijs SB, Dijkers E, Roldaan AC, Cheung D, Bel EH, Sterk PJ. Exhaled breath profiling enables discrimination of chronic obstructive pulmonary disease and asthma. Am J Respir Crit Care Med. 2009 Dec 1;180(11):1076-82. doi: 10.1164/rccm.200906-0939OC. Epub 2009 Aug 27.

    PubMed 19713445
  • American Thoracic Society; European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med. 2005 Apr 15;171(8):912-30. doi: 10.1164/rccm.200406-710ST. No abstract available.

    PubMed 15817806
  • Clement PA, Gordts F; Standardisation Committee on Objective Assessment of the Nasal Airway, IRS, and ERS. Consensus report on acoustic rhinometry and rhinomanometry. Rhinology. 2005 Sep;43(3):169-79.

    PubMed 16218509
  • Serrano C, Valero A, Picado C. [Nasal nitric oxide]. Arch Bronconeumol. 2004 May;40(5):222-30. doi: 10.1016/s1579-2129(06)70088-x. No abstract available. Spanish.

    PubMed 15117622

Questions about this trial

What is this clinical trial studying?

A study testing Nasal nitrous oxide and Electronic nose in people with Allergic Rhinitis and Non-Allergic Rhinitis, run by Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau at 1 site in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 17 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 13 Feb 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Values of nNO measure as parts per billions (ppb) (time frame: 12 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02476929, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Feb 2020.

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