INTRODUCTION
The salso-bromo-iodine water of Salsomaggiore has a very high percentage of iodine (0.054 g/l) and bromine (0.23 g/l). It is well tolerated by the organism on account of its chemical affinity with organic liquids (1). Its main therapeutic properties are (1,2):
• general and local anti-inflammatory action and stimulation of tissue-healing and regenerative processes;
• antiseptic action and restoration of mucociliary activity of the upper airways;
• stimulatory action on reciprocation (thyroid and lymphgland apparatus, the organism’s centre of defence mechanisms). In otorhinolaryngology, the use of salso-bromoiodine waters finds application in the treatment of the following disorders: chronic and eczematous rhinitis, chronic tonsillitis and pharyngitis, tonsil and adenoid hypertrophy, inflammation of the auditory tube and tubotympanum, purulent and catarrhal processes of the middle ear, rhinogenous deafness, recurrent and/or obstructive chronic bronchitis and bronchiectasis (2-8). The objective of our study was to test the effect of the salso-bromo-iodine water of Salsomaggiore on subjects affected by specific allergic rhinitis (Dermatophagoides farinae and Dermatophagoides pteronyssimus) after one, six and twelve months of therapy.
MATERIAL AND METHODS
Our study was conducted on 80 patients with specific allergic rhinitis (positivity for Dermatophagoides farinae and Dermatophagoides pteronyssimus, aged between 23 and 76 years (mean age 48) and randomly subdivided into two numerically equal groups: group A (experimental group) and group B (control group). Patients with active tubercular processes, uncompensated cardiopathy, nephropathy, neoplasia or acute infective processes were excluded. Before treatment, and one, six and twelve months after the beginning treatment, all patients underwent the following procedures:
1. anterior rhinoscopy;
2. fibrolaryngoscopy;
3. active anterior rhinomanometry (considering the pathological values of endonasal total resistances > 0.25 Pascal and of the punctual resistances > 0.6 Pascal);
4. prick test;
5. RAST screening;
6. evaluation of total serum IgE (normal values: 0-25 mg/ dl) and serum IgA (normal values:70-400 mg/dl);
7. testing of mucociliary transport time (by means of 3% saccharose in charcoal; normal values: 12-16 min.);
8. appraisal of subjective symptoms with reference values ranging from 0 to 10 (0:no symptoms, 10:extremely annoying symptoms), as recommended by other authors (9-12). Group A was treated with salso-bromo-iodine water from Salsomaggiore in the form of endonasal spray administered in seven daily applications: this water has a salt content of 151.5 grams (made up mainly of sodium chloride, iodine and bromine salts), a temperature of 16oC and a density of 16 Baumé degrees; it has a high content of ferrous salts and a very high percentage of iodine (0.054 g/l) and bromine (0.23 g/l) in the solution (1).
Group B received physiological solution for the same period and at the same dosage as group A.
RESULTS
In group A patients:
• subjective assessment of symptoms decreased from a mean value of 7.51 before therapy to values of 3.5, 3 and 2.79 after 1, 6 and 12 months, respectively. Statistical analysis of the data showed a significant reduction (p<0.05, Wilcoxon test);
• mucociliary transport time fell from an initial mean value of 19.5 min to 13.6 min, 12.9 min and 12.6 min after 1, 6 and 12 months, respectively. The Wilcoxon test again revealed statistical significance (p<0.05);
• total nasal resistances declined from the pre-treatment mean of 1.92 Pasc/cc (MAD = 0.55) to 1.86 Pasc/cc (MAD = 0.21), 1.51 Pasc/cc (MAD = 0.30) and 1,43 Pasc/cc (MAD=0.25) after 1, 6 and 12 months, respectively. The Wilcoxon test showed a statistically significant reduction (p<0.05) in total resistances (Graphics 1 and 2);
• total serum IgE fell from a mean pre-treatment value of 137.7 UlqE/ml to 101 UlqE/ml, 92.4 UlqE/ml and 86 UlqE/ml after 1, 6 and 12 months, respectively;
• serum IgA (pre-treatment mean: 253,2 mg/dl) rose to a mean value of 260.7 mg/dl, 261.4 mg/dl and 270 mg/ dl after 1, 6 and 12 months of therapy. In Group B patients:
• subjective assessment of symptoms declined from a pre-therapy mean of 7.54 to 4.6 and 4.8 after 1 and 6 months, respectively, but subsequently increased to a final value of 5.80 after a year; the Wilcoxon test did not show statistically significant values (p>0.05);
• mucociliary transport time remained almost unchanged, at a mean of 18.2 min.;
• total nasal resistances rose from a mean pre-treatment value of 2.2 Pasc/cc (MAD = 0.55) to 2.26 Pasc/cc (MAD = 0.21), 2.39 Pasc/cc (MAD = 0.30) and 2.43 Pasc/ cc (MAD = 0.29) after 1, 6 and 12 months, respectively; the Wilcoxon test did not show a statistically significant modification (p>0.05) (Graphics 1 and 2).
• neither a significant reduction in IgE nor a significant increase IgA were seen. DISCUSSION Our data indicate that long-term crenotherapy is a valid and well tolerated treatment in patients affected by allergic rhinitis (positivity for Dermatophagoides farinae and pteronyssimus.
The reduction in serum IgE and the increase in IgA reflect the immunological variations: crenotherapy-induced stimulation of the endothelial reticulum system (ERS) evidences the efficacy of this treatment in cases of catarrhal and exudatory diathesis (in which deficiencies in the organic defence mechanisms underlie the pathogenesis) (3,12). In mucous-secretory disorders, the effect of thermal water inhalation – vasodilatation accompanied by exudation, as a result of the contact between the inhaled water and the respiratory mucosa – helps to improve the relationship between the mucous-protein complexes and the water: initially, this action is congestive, subsequently, it becomes an anti-catarrhal, anti-inflammatory, antiseptic and immunostimulant action (increase of total serum IgA and reduction of total serum IgE) (3,6,13-15). Decongestion of the turbinates explains the significant reduction in endonasal resistances evidenced by active anterior rhinomanometry.
This effect, together with the immunological modifications induced by this particular crenotherapy, has not been reported in the literature. Cleansing of the superficial nasal mucosa is followed by a reduction in the bacterial flora, while the mineral osmotic activity of the water induces qualitative normalization of the mucosa and increases the expulsive ability of the mucosa and leukopedesis, thereby improving local defence processes (13,16-18). The renewed trophism of the nasal and rhinopharyngeal mucosa, as revealed by rhinoscopy after one month of therapy, promotes the synthesis of serum IgA, improving resistance to infectious agents and guaranteeing two other important nasal functions:
the humidification and warming of inspired air (3,12,19). The normalizing action on the mucosa and the mucociliary clearance is able to reduce the number of recurrences of the pathology, thereby sustaining the improvement in symptoms reported by patients (3). Administration by means of nasal spray enables the interior of the nasal cavities, turbinates, rhinopharynx, oral cavity and ethmoid to be reached, promoting:
• a cleansing action on the mucosa of the structures involved and reduced contact with several allergens; as a result of the reduced sensitization, general and local responses are mitigated (1);
• an absorption of active substances through the ethmoid pathway.
It should be borne in mind that many drugs are transported through the ethmoid cribrate sheet and reach the hypophysis and hypothalamic structures, determining variations in secretory activity (1). The administration of salso-bromo-odine water by means of inhalation involves a true anti-inflammatory action at the hypothalamic level, activating the adrenocortical system, followed by a hypersecretion of ACTH/cortisol and beta endorphine (1).
CONCLUSIONS
The data obtained from group A indicate that thermal therapy can bring about clinically evident results both after one month and after one year of treatment, producing sustained improvements in subjective symptoms and in the data yielded by clinical examinations.
Stimulation of the nonspecific immune response, together with the antiinflammatory action of salso-bromo-iodine water reduces hyperactivity, determining a decrease in the frequency and intensity of recurrences, thereby alleviating patient discomfort and lowering the social cost of disease management.
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ENT Department of the University of Genova, Italy.
Address for correspondence: Renzo Mora, MD . San Martino Hospital, Padiglione Due . Largo R. Benzi 10, 16132 . Genova, Italy . Phone: +390103537631 .
Fax: +390103537684 . E-mail: renzomora@libero.it
Artigo recebido em 20 de fevereiro de 2003. Artigo aceito em 18 de maio de 2003.
