title: Crenotherapy modulates the expression of proinflammatory cytokines and immunoregulatory peptides in nasal secretions of children with chronic rhinosinusitis.
abstract: BACKGROUND
  The effect of crenotherapy on major mucosal markers of inflammation, TNF alpha, human beta-defensins 2 (hBD-2), and calprotectin, are largely unexplored in pediatric chronic rhinosinusitis (CRS). The aim of this study was to investigate the effects of crenotherapy  with sulfate-sodium-chloride water on mucosal markers of inflammation in children with CRS.
  
  
  METHODS
  Children with CRS received 15-day crenotherapy consisting of sulfate-sodium-chloride thermal water inhalations by nasal aerosol (15 minutes/day). Concentrations of nasal  mucosal markers of inflammation (TNF alpha, hBD-2, and calprotectin) were measured before and after crenotherapy. Presence of specific symptoms (nasal obstruction, nasal discharge, facial pain, sense of smell, and cough), value of symptoms score sino-nasal 5 (SN5), quality of life (QoL) score  (1 [worse] to 10 [optimal]) were also assessed.
  
  
  RESULTS
  After crenotherapy a significant reduction was observed in TNF alpha (from 0.14 ± 0.02 to 0.08 ± 0.01; p < 0.001), calprotectin (from 2.9 ± 1.0 to 1.9 ± 0.5; p < 9.001), and hBD-2  (from 2.0 ± 0.1 to 0.9 ± 0.6; p < 0.001) concentrations. A significant (p < 0.05) reduction in number of subjects presenting symptoms of nasal obstruction (100% versus 40%), nasal discharge (33% versus 13%), facial pain (30% versus 10%), and sense of smell (60% versus 20%)  was observed. A significant improvement of SN5 (from 3.07 ± 0.76 to 2.08 ± 0.42; p < 0.001) was observed after the crenotherapy. QoL also improved after crenotherapy (from 4.2 ± 1.1 to 6.6 ± 1.0; p < 0.001).
  
  
  CONCLUSIONS
  Crenotherapy induced  a down-regulation of nasal mucosal inflammatory mediators in children with CRS.
authors.affiliation: Department of Pediatrics, University of Naples Federico II, Via S. Pansini 5, Naples, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Passariello
authors.forename: Margherita
authors.initials: M
authors.lastname: Di Costanzo
authors.forename: Gianluca
authors.initials: G
authors.lastname: Terrin
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannotti
authors.forename: Pietro
authors.initials: P
authors.lastname: Buono
authors.forename: Umberto
authors.initials: U
authors.lastname: Balestrieri
authors.forename: Gianni
authors.initials: G
authors.lastname: Balestrieri
authors.forename: Enrico
authors.initials: E
authors.lastname: Ascione
authors.forename: Monica
authors.initials: M
authors.lastname: Pedata
authors.forename: Francesco Berni
authors.initials: FB
authors.lastname: Canani
authors.forename: Roberto Berni
authors.initials: RB
authors.lastname: Canani
mesh_terms: D001452:Balneology; D002675:Child, Preschool; D002908:Chronic Disease; D015536:Down-Regulation; D005260:Female; D006801:Humans; D056747:Immunomodulation; D018836:Inflammation Mediators / Q000378:metabolism; D039841:Leukocyte L1 Antigen Complex / Q000235:genetics / Q000378:metabolism; D008297:Male; D008900:Mineral Waters / Q000008:administration & dosage* / Q000009:adverse effects; D009297:Nasal Mucosa / Q000187:drug effects / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D059085:Nasal Sprays; D011788:Quality of Life; D012220:Rhinitis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D012852:Sinusitis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics / Q000378:metabolism; D023083:beta-Defensins / Q000235:genetics / Q000378:metabolism
chemical_list: C106641:DEFB4A protein, human; D018836:Inflammation Mediators; D039841:Leukocyte L1 Antigen Complex; D008900:Mineral Waters; D059085:Nasal Sprays; D014409:Tumor Necrosis Factor-alpha; D023083:beta-Defensins