International Rhinologic Society Rhinology 0300-0729 59 5 2021 10 1 34487516 In search of the allergen-driven chronic rhinosinusitis endotype 409 409 EN A.R. Sedaghat 1Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA 2927 10.4193/Rhin21.805

International Rhinologic Society Rhinology 0300-0729 59 5 2021 10 1 34666340 Nasopharyngeal versus nasal swabs for detection of SARS-CoV-2: a systematic review 410 421 EN A.J. Gadenstaetter Department of Otolaryngology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria C.D. Mayer Department of Otolaryngology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria 2 Department of Otolaryngology, Klinik Favoriten, Wiener Gesundheitsverbund, Vienna, Austria L.D. Landegger Department of Otolaryngology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria 2917 10.4193/Rhin21.162 Nasopharyngeal swabbing (NPS) coupled with RT-PCR is the current gold standard for detecting SARS-CoV-2 infections. However, numerous studies have recently demonstrated the advantages of alternative nasal specimen collection approaches over NPS specifically for COVID-19 diagnosis. The present review was conducted according to PRISMA guidelines and summarises the current literature to give a clear overview of nasal specimen collection methods for SARS-CoV-2 detection. Publications investigating NPS and at least one other form of nasal specimen collection in combination with RT-PCR for viral detection in the context of COVID-19 were assessed. We identified 425 articles and ultimately included 18 studies in this systematic review. The suitable publications evaluated different forms of nasal specimen collection, with anterior nasal swabbing (ANS) and midturbinate swabbing (MTS) being the most frequently examined techniques. The analysed studies report sensitivity and specificity results (67.5-96.2% and 97.9-100.0%, respectively) similar to those achieved via NPS, especially in the early stages of disease or when paired with an oropharyngeal swab. Results from these studies suggest that ANS and MTS are suitable alternatives to NPS for COVID-19 testing. Due to their ease of collection, ANS and MTS collection techniques may facilitate broader testing strategies and allow for economization of medical staff.

International Rhinologic Society Rhinology 0300-0729 59 5 2021 10 1 34463311 Meta-analyses of the efficacy of pharmacotherapies and sublingual allergy immunotherapy tablets for allergic rhinitis in adults and children 422 432 EN E.O. Meltzer Allergy and Asthma Medical Group and Research Center, University of California School of Medicine, San Diego, CA, USA D. Wallace Nova Southeastern Allopathic Medical School, Davie, FL, USA H.S. Friedman DataMed Solutions, New York, NY, USA P. Navaratnam DataMed Solutions, New York, NY, USA E.P. Scott Scott Medical Communications, Tyler, TX, USA H. Nolte ALK-Abell�, Bedminster, NJ, USA 2925 10.4193/Rhin21.054 Background: Treatment options for seasonal and perennial allergic rhinitis (SAR/PAR) include pharmacotherapies and allergy immunotherapy. These meta-analyses evaluated the efficacy of pharmacotherapies and sublingual immunotherapy tablets (SLIT-tablets) versus placebo on nasal symptoms associated with SAR and PAR. Methods: Randomized, double-blind, placebo-controlled trials were identified from systematic PubMED/EMBASE searches through 7/18/2019 (PROSPERO protocol CRD42018105632). The primary outcome was mean numerical difference in total nasal symptom score (TNSS; 0-12) between active treatment and placebo at the end of the assessment period. Random-effects meta-analyses estimated the mean difference for each medication group weighted by the inverse of the trial variance. Publication bias assessments and sensitivity analyses were conducted. Results: Rescue symptom-relieving pharmacotherapy was prohibited in most pharmacotherapy trials but was allowed in all SLIT-tablet trials. For adult/adolescent SAR, the mean numerical difference (95% CI) in TNSS versus placebo was: intranasal corticosteroids (INCS)=1.38 (1.18, 1.58; 39 trials); combination intranasal antihistamine/INCS=1.34 (1.15, 1.54; 4 trials); intranasal antihistamines=0.72 (0.56, 0.89; 13 trials); oral antihistamine=0.62 (0.35, 0.90; 18 trials); SLIT-tablets=0.57 (0.41, 0.73; 4 trials); and montelukast=0.48 (0.36, 0.60; 10 trials). For adult/adolescent PAR, mean difference in TNSS versus placebo (95% CI) was: INCS=0.82 (0.66, 0.97; 14 trials); SLIT-tablets=0.65 (0.42, 0.88; 3 trials); and oral antihistamine=0.27 (0.11, 0.42; 3 trials). The number of eligible trials limited meta-analyses for pediatric SAR/PAR. Conclusions: All treatments significantly improved nasal symptoms versus placebo. SLIT-tablets provided improvement in TNSS despite access to rescue symptom-relieving pharmacotherapy. Extensive trial heterogeneity and strong indications of publication bias preclude the comparison of treatment effects among treatment classes.

International Rhinologic Society Rhinology 0300-0729 59 5 2021 10 1 34254061 Elective neck irradiation in the management of esthesioneuroblastoma: a systematic review and meta-analysis 433 440 EN A. De Virgilio Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy A. Costantino Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy D. Sebastiani Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy E. Russo Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy C. Franzese Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Radiotherapy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy G. Mercante Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy M. Scorsetti Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Radiotherapy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy G. Spriano Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy 2908 10.4193/Rhin21.139 Background: There is no consensus about the optimal management of the neck in clinically node negative esthesioneuroblastoma (ENB). The aim of this study is to assess the impact of elective neck irradiation (ENI) in terms of regional disease control and survival. Methods: The study was performed according to the PRISMA guidelines searching on Scopus, PubMed/MEDLINE, and Google Scholar databases. The primary outcome was the regional recurrence rate (RRR), that was reported as odds ratio (OR) and 95% confidence interval (CI). Secondary outcomes were the overall survival (OS), and the distant-metastases free survival (DMFS), that were reported as logarithm of the hazard ratios (logHRs) and 95% confidence intervals (CIs). Results: A total of 489 clinically node negative patients were included from 9 retrospective studies. ENI significantly reduced the risk of regional recurrence compared to no treatment. No difference was measured between ENI and observation, according to both OS and DMFS. No stratified analysis could be performed based on Kadish stage and Hyams grade. Conclusions: ENI should be recommended to improve the regional disease control. No advantage was measured in terms of survival or distant metastases with a low quality of evidence. Further prospective studies should be designed to understand if ENI could be avoided in early stage and low-grade tumors.

International Rhinologic Society Rhinology 0300-0729 59 5 2021 10 1 34339483 Differences and similarities between the upper and lower airway: focusing on innate immunity 441 450 EN H.-J. Cho Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea; Global Research Laboratory for Allergic Airway Disease, Yonsei University College of Medicine, Seoul, Korea; The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea J.G. Ha Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea S.N. Lee Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea 2 Global Research Laboratory for Allergic Airway Disease, Yonsei University College of Medicine, Seoul, Korea C.-H. Kim Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea; The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea D.-Y. Wang Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore J.-H. Yoon Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea; Global Research Laboratory for Allergic Airway Disease, Yonsei University College of Medicine, Seoul, Korea; The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea 2916 10.4193/Rhin21.046 The nose is the first respiratory barrier to external pathogens, allergens, pollutants, or cigarette smoke, and vigorous immune responses are triggered when external pathogens come in contact with the nasal epithelium. The mucosal epithelial cells of the nose are essential to the innate immune response against external pathogens and transmit signals that modulate the adaptive immune response. The upper and lower airways share many physiological and immunological features, but there are also numerous differences. It is crucial to understand these differences and their contribution to pathophysiology in order to optimize treatments for inflammatory diseases of the respiratory tract. This review summarizes important differences in the embryological development, histological features, microbiota, immune responses, and cellular subtypes of mucosal epithelial cells of the nose and lungs.

International Rhinologic Society Rhinology 0300-0729 59 5 2021 10 1 34472546 Association between air pollution and chronic rhinosinusitis: a nested case-control study using meteorological data and national health screening cohort data 451 459 EN J.H. Wee Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea C. Min Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea; Graduate School of Public Health, Seoul National University, Seoul, Korea H.J. Jung Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea M.W. Park Department of Otorhinolaryngology-Head and Neck Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea B. Park Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea H.G. Choi Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea; Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea 2926 10.4193/Rhin21.141 Background: Inconsistent results about the effect of air pollution on chronic rhinosinusitis (CRS) have been reported. This study aimed to evaluate the impact of meteorological conditions/air pollution on the prevalence of CRS in adult Koreans. Methodology: The data from the Korean National Health Insurance Service-Health Screening Cohort from 2002 through 2015 were used. A CRS group (defined as ICD-10 codes J32, n=6159) was matched with a control group (n=24,636) in 1:4 ratios by age, sex, income, and region of residence. The meteorological conditions and air pollution data included the daily mean, highest, and lowest temperature (°C), daily temperature range (°C), relative humidity (%), ambient atmospheric pressure (hPa), sunshine duration (hr), and the rainfall (mm), SO2 (ppm), NO2 (ppm), O3 (ppm), CO (ppm), and PM10 (μg/m3) levels before the CRS diagnosis. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for CRS were analyzed using logistic regression analyses. Results: When the NO2 level increased by 0.1 ppm, the odds for CRS increased 5.40 times, and when the CO level increased by 1 ppm and PM10 increased by 10 μg/m3, the odds for CRS decreased 0.75 times and 0.93 times, respectively. Other meteorological conditions, such as the mean/highest/lowest temperature, temperature range, rainfall and other air pollution, such as SO2 and O3, were not statistically significant. NO2 for 90 days before the index date increased the risk of CRS in all subgroups, except for the nasal polyp and older age subgroups. Conclusion: CRS is related to high concentrations of NO2.

International Rhinologic Society Rhinology 0300-0729 59 5 2021 10 1 34282808 Viral stimulation modulates endotype-related ACE2 expression in eosinophilic chronic rhinosinusitis 460 469 EN S.-N. Hong Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea; Sensory Organ Research Institute, Seoul National University Medical Research Center J.K. Kim Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea; Sensory Organ Research Institute, Seoul National University Medical Research Center J.-A. Kim Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea; Sensory Organ Research Institute, Seoul National University Medical Research Center H. Cha Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea; Sensory Organ Research Institute, Seoul National University Medical Research Center J.Y. Kim Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea; Sensory Organ Research Institute, Seoul National University Medical Research Center H.-S. Lim Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea; Sensory Organ Research Institute, Seoul National University Medical Research Center K.M. Eun Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea; Sensory Organ Research Institute, Seoul National University Medical Research Center D.W. Kim Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea; Sensory Organ Research Institute, Seoul National University Medical Research Center 2910 10.4193/Rhin21.001 Background: Angiotensin-converting enzyme 2 (ACE2), a receptor targeted by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly expressed in the nasal mucosa. Chronic rhinosinusitis (CRS) shows diverse endotypes and is aggravated by viral infection. Whether viral stimulation and CRS endotype influence ACE2 expression remains unclear. We investigated the expression of ACE2 and the transmembrane protease, serine 2 (TMPRSS2), which mediate the entry of SARS-CoV-2 into cells, and assessed polyinosinic:polycytidylic acid (poly[I:C])-induced changes based on CRS endotype. Methodology: ACE2 and TMPRSS2 expression was evaluated based on CRS phenotype, endotype, and tissue type. Correlations between ACE2/TMPRSS2 expression and inflammatory mediators in nasal polyps (NP) were examined. Air-liquid interface culture experiments were performed to assess the effects of major cytokines or poly(I:C) stimulation on ACE2/TMPRSS2 expression in primary epithelial cells from healthy nasal mucosa, eosinophilic NP (ENP), and non-eosinophilic NP (NENP). Results: In primary nasal epithelial cells, interleukin (IL)-13 decreased ACE2 expression but increased TMPRSS2. Eosinophilic CRS showed lower ACE2 expression than non-eosinophilic CRS, regardless of CRS phenotype. CRS endotype was an independent factor associated with ACE2/TMPRSS2 expression in NP. Serum and tissue eosinophilic marker levels were inversely correlated with ACE2 expression, whereas tissue neutrophilic marker levels and ACE2 expression were positively correlated in NP. ACE2 expression was suppressed in ENP tissues; however, a combination of poly(I:C) and IL-13 induced ACE2/TMPRSS2 upregulation in ENP. Conclusions: ENP tissues have lower ACE2 expression than NENP; however, viral stimulation promotes ACE2/TMPRSS2 upregulation in ENP.

International Rhinologic Society Rhinology 0300-0729 59 5 2021 10 1 34398939 Ion concentrations in nasal airway surface liquid: a prediction model for the identification of cystic fibrosis carriers 470 474 EN N. Malagutti ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy V. Fancello ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy A. Cariani Department of Biochemistry and Molecular Biology, University of Ferrara, Ferrara, Italy F. Battistini Cystic Fibrosis Regional Center, Bufalini Hospital, Cesena, Italy C. Fabbri ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy A. Di Laora ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy G. Valpiani Research Innovation Office, S. Anna University Hospital of Ferrara, Ferrara, Italy C. Morotti Research Innovation Office, S. Anna University Hospital of Ferrara, Ferrara, Italy V. Iannini ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy M. Borin ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy A. Ravani Unit of Medical Genetics Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy C. Bianchini ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy A. Ciorba ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy F. Stomeo ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy S. Pelucchi ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy 2918 10.4193/Rhin21.064 Background: Cystic fibrosis (CF) carriers seem to have a higher risk to develop chronic rhino-sinusitis (CRS), although the full underlying mechanisms are unknown. Ion concentrations in nasal airway surface liquid (ASL) may be influenced by the heterozygosity for CF gene mutation, with possible impacts on the development of CRS. Methods: A cheap and feasible standardized technique was designed to measure the ion levels in nasal ASL. With this purpose we collected, under basal conditions, samples from the nasal cavity of 165 adults: 14 homozygous for CF, 83 carriers and 68 healthy controls. Sodium (Na) and Chlorine (Cl) concentrations were then evaluated among different groups. Results: Statistical analysis revealed a significant difference of Na and Cl values between controls and carriers and between controls and homozygotes. Receiver operating characteristic (ROC) curves and derived indicators (Youden�s index and Area Under the Curve, AUC) were used to further evaluate the diagnostic capability of Na and Cl concentrations to differentiate heterozygotes from controls. ROC curves demonstrated that the optimal diagnostic cut-off value of Na is at 124, and the optimal cut-off value of Cl is at 103,2. Conclusion: ASL sampling can be considered a new diagnostic tool for providing quantitative information on nasal ion composition. According to our findings, Na and Cl concentrations of nasal ASL could represent a useful tool to assess heterozygotes and healthy controls.

International Rhinologic Society Rhinology 0300-0729 59 5 2021 10 1 34428266 Assessment of the anterior superior alveolar nerve and its impact on surgery of the lateral nasal wall 475 480 EN A. Machado Department of Otolaryngology, Centro Hospitalar Universitario do Porto, Porto, Portugal; Faculdade de Ciencias da Saude â€" Universidade da Beira Interior, Covilha, Portugal H.R. Briner ORL-Zentrum - Otorhinolaryngology and Facial Plastic Surgery, Hirslanden Klinik, Zurich, Switzerland B. Schuknecht Medizinisch Radiologisches Institut, Zurich, Switzerland D. Simmen ORL-Zentrum - Otorhinolaryngology and Facial Plastic Surgery, Hirslanden Klinik, Zurich, Switzerland 2919 10.4193/Rhin21.223 Background: The anterior superior alveolar nerve (ASAN) plays a major role in innervation of the lateral nasal wall. Its damage during nasal surgery can cause dental paraesthesia and numbness around the upper lip. Methodology: Retrospective evaluation of the computed tomographic (CT) scans of 50 consecutive patients analysing 100 sides. We measured the mean distance from the shoulder of the inferior turbinate to the descending portion of the anterior superior alveolar nerve, to the anterior superior alveolar canal and the anterior-posterior distance between the â€�shoulderâ€� of the inferior turbinate and the pyriform aperture. Results: The mean distance from the shoulder of the inferior turbinate to the descending portion of the anterior superior alveolar nerve was 6.4 ± 2.33 mm, with no difference between sides The mean relative height of the shoulder in relation to the anterior superior alveolar nerve canal was 4.78± 2.31mm with no significant difference between the two sides. The anterior-posterior distance between the â€�shoulderâ€� of inferior turbinate and the pyriform aperture was 6.96± 2.28mm, with no significant difference between the two sides. Conclusions: We found the anterior superior alveolar nerve to be a constant landmark in the lateral nasal wall. Therefore, the course of the ASAN should be assessed on a CT scan when a surgical approach through the pyriform aperture or anterior medial wall of the maxillary sinus is planned.

International Rhinologic Society Rhinology 0300-0729 59 5 2021 10 1 34459840 Face masks during COVID-19 pandemic lockdown and self-reported seasonal allergic rhinitis symptoms 481 484 EN G. Liccardi Postgraduate School of Respiratory Medicine, Department of Experimental Medicine. University of Rome "Tor Vergata", Rome, Italy M.B. Bil� Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti, Ancona - Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Italy M. Milanese Division of Pulmonology, S.Corona Hospital, Pietra Ligure, Savona, Italy M. Martini Global Clinical Development, Chiesi Farmaceutici, Parma, Italy L. Calzetta Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy F. Califano Allergy and Clinical Immunology. �G. Fucito� Hospital and University Hospital, Salerno, Italy L. Carucci Department of Translational Medical Sciences and Interdepartmental Center for Research in Basic and Clinical Immunology, Sciences, University of Naples Federico II, Naples, Italy A. Ciccarelli Allergy Unit, Presidio Sanitario Polispecialistico �Loreto Crispi� Naples, Italy M. Cutajar Allergy Center, Division of Internal Medicine. Ospedali Riuniti Penisola Sorrentina, Sorrento, Naples, Italy P. D'Auria Regional Environmental Protection Agency Campania Region (ARPAC), Naples, Italy F. De Bartolomeis Allergy Unit, High Speciality �San Giuseppe Moscati� Hospital, Avellino, Italy I. Dello Iacono Unit of Allergology. Division of Internal Medicine, �Fatebenefratelli� Hospital, Benevento, Italy A. Franzese Allergy and Clinical Immunology Unit, ASL Na 3 sud and ASL Na 2 nord, Naples, Italy D. Gargano Allergy Unit, High Speciality �San Giuseppe Moscati� Hospital, Avellino, Italy G. Inciso Allergy Unit, ASL Na 3 (Sanitary District 59), Meta di Sorrento (Naples), Italy A.C. Giordano Postgraduate School of Internal Medicine. University of Salerno, Salerno, Italy R. Iannaccone Unit of Allergology. Division of Internal Medicine, �Fatebenefratelli� Hospital, Benevento, Italy M. Lo Schiavo Allergy and Clinical Immunology. �G. Fucito� Hospital and University Hospital, Salerno, Italy L. Nappi L.N. Center, Scafati (Salerno), Italy F. Madonna Allergy Unit. ASL (Sanitary District n°12), Caserta, Italy C. Montera Allergy and Clinical Immunology. �G. Fucito� Hospital and University Hospital, Salerno, Italy G. Onorati Regional Environmental Protection Agency Campania Region (ARPAC), Naples, Italy A. Papa ASL (Sanitary District), Avellino, Italy A. Pedicini Unit of Allergology, Division of Internal Medicine, �Fatebenefratelli� Hospital, Benevento, Italy G. Sabatino G.S. Center, Salerno, Italy C. Sacerdoti Diagnostic Center Basile, Naples, Italy A. Savoia Unit of Allergology. Division of Internal Medicine, �Fatebenefratelli� Hospital, Benevento, Italy E. Scopano Air pollution Unit, Regional Environmental Protection Agency Campania Region (ARPAC), Caserta, Italy M.P. Iannotta Air pollution Unit, Regional Environmental Protection Agency Campania Region (ARPAC), Caserta, Italy M. Bartiromo Air pollution Unit, Regional Environmental Protection Agency Campania Region (ARPAC), Caserta, Italy G. Del Monaco Air pollution Unit, Regional Environmental Protection Agency Campania Region (ARPAC), Caserta, Italy P. Rogliani Postgraduate School of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy; Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome, Tor Vergata, Rome, Italy 2923 10.4193/Rhin21.202

International Rhinologic Society Rhinology 0300-0729 59 5 2021 10 1 34428265 Habitual cold-water swimming and upper respiratory tract infection 485 487 EN N. Collier Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK M. Lomax Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK M. Harper Consultant Anaesthetist, Royal Sussex County Hospital, Brighton, UK M. Tipton Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK H. Massey Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK 2920 10.4193/Rhin21.068 It has long been claimed that non-wetsuit cold water swimming (CWS) benefits health (1), and anecdotally cold-water swimmers claimed to suffer fewer and milder infections, though this was not directly measured. A boost to immunity is biologically plausible: stress hormones are released during cold-water immersion (2), and short-term stress may ready the immune system for injury or infection (3). However, very few studies have investigated immune system markers and/or actual illness in habitual cold-water swimmers.

International Rhinologic Society Rhinology 0300-0729 59 5 2021 10 1 34459839 What’s in a name - is CCAD really PPAR? 488 488 EN G.K. Scadding RNENT Hospital, London, United Kingdom 2922 10.4193/Rhin20.629