Crenotherapy modulates the expression of proinflammatory cytokines and immunoregulatory peptides in nasal secretions of children with chronic rhinosinusitis

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). Conclusion: Crenotherapy induced a down-regulation of nasal mucosal inflammatory mediators in children with CRS. (Am J Rhinol Allergy 26, e15-e19, 2012; doi: 10.2500/ajra.2012.26.3733)