El consumo de tabaco empeora la inflamación nasal y la calidad de vida en pacientes con rinitis alérgica

Autores/as

Palabras clave:

rinitis alérgica, tabaco, inflamación, calidad de vida

Resumen

Se ha descripto que la exposición al humo de tabaco genera un aumento de parámetros de atopía y de síntomas de rinitis. Pero también se reportó que los síntomas nasales y la calidad de vida en pacientes fumadores con RA no eran significativamente distintos. Ante esta dualidad, se propuso evaluar calidad de vida y parámetros inflamatorios de atopía, entre pacientes con RA fumadores activos y no fumadores.

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Referencias

Solé D, Mallol J, Camelo-Nunes IC, Wandalsen GF; Latin American ISAAC Study Group. Prevalence of rhinitis-related symptoms in Latin American children - results of the International Study of Asthma and Allergies in Childhood (ISAAC) phase three. Pediatr Allergy Immunol. 2010 Feb;21(1 Pt 2):e127-36. 2 https://doi.org/10.1111/j.1399-3038.2009.00947.x

Allergic Rhinitis - Diagnosis and Treatment. En: Holgate ST, Church MK editors. Allergy. Hong Kong: Mosby -Wolfe; 1995:18.1-18.10.

Baiardini I, Braido F, Tarantini F, Porcu A, Bonini S, Bousquet PJ, Zuberbier T, Demoly P, Canonica GW; GA2LEN. ARIA-suggested drugs for allergic rhinitis: what impact on quality of life? A GA2LEN review. Allergy. 2008 Jun;63(6):660-9. https://doi.org/10.1111/j.1398-9995.2008.01649.x

Baena-Cagnani CE, Canonica GW, Zaky Helal M, Gómez RM, Compalati E, Zernotti ME, Sanchez-Borges M, Morato Castro FF, Murrieta Aguttes M, López-Garcia A, Tadros FA; ISMAR Study Group. The international survey on the management of allergic rhinitis by physicians and patients (ISMAR). World Allergy Organ J. 2015 Mar 20;8(1):10. https://doi.org/10.1186/s40413-015-0057-0

Skoner DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol. 2001 Jul;108(1 Suppl):S2- 8. https://doi.org/10.1067/mai.2001.115569

Ait-Khaled N, Pearce N, Anderson HR, Ellwood P, Montefort S, Shah J, and the ISAAC Phase Three Study Group. Global map of the prevalence of symptoms of rhinoconjunctivitis in children: The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. Allergy. 2009 Jan;64(1):123-48. https://doi.org/10.1111/j.1398-9995.2008.01884.x

Izquierdo-Domínguez A, Valero AL, Mullol J. Comparative analysis of allergic rhinitis in children and adults. Curr Allergy Asthma Rep. 2013 Apr;13(2):142-51. 39 https://doi.org/10.1007/s11882-012-0331-y

Juniper EF, Howland WC, Roberts NB, Thompson AK, King DR. Measuring quality of life in children with rhinoconjunctivitis. J Allergy Clin Immunol. 1998 Feb;101(2 Pt 1):163-70. https://doi.org/10.1016/S0091-6749(98)70380-X

Dietz de Loos DA, Segboer CL, Gevorgyan A, Fokkens WJ. Diseasespecific quality-of-life questionnaires in rhinitis and rhinosinusitis: review and evaluation. Curr Allergy Asthma Rep. 2013 Apr;13(2):162-70. https://doi.org/10.1007/s11882-012-0334-8

Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008 Apr;63 Suppl 86:8-160.

Ortiz RA, Barnes KC. Genetics of allergic diseases. Immunol Allergy Clin North Am. 2015 Feb;35(1):19-44. https://doi.org/10.1016/j.iac.2014.09.014

Duse M, Donato F, Porteri V, Pirali F, Spinoni V, Tosoni C, Vettore M, Lombardi C. High prevalence of atopy, but not of asthma, among children in an industrialized area in North Italy: the role of familial and environmental factors--a population-based study. Pediatr Allergy Immunol. 2007 May;18(3):201-8. https://doi.org/10.1111/j.1399-3038.2006.00523.x

Dykewicz MS. Allergic Rhinitis Diagnostic Work-Up Overview. En: Global Atlas of Allergic Rhinitis and Chronic Rhinosinusitis. www.eaaci.org; 2015:150-51.

Stevens WW, Grammer LC 3rd. Occupational rhinitis: an update. Curr Allergy Asthma Rep. 2015 Jan;15(1):487. 15. Cingi C, Demirbas D, Songu M. Allergic rhinitis caused by food allergies. Eur Arch Otorhinolaryngol. 2010 Sep;267(9):1327-35. https://doi.org/10.1007/s00405-010-1280-5

Blanca-López N, Barrionuevo E, Andreu I, Canto MG. Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs: from phenotyping to genotyping. Curr Opin Allergy Clin Immunol. 2014 Aug;14(4):271-7. https://doi.org/10.1097/ACI.0000000000000077

Corren J, Baroody FM, Pawankar R. Allergic and Non-Allergic Rhinitis. En: Adkinson NF, Bochner BS, Burks AW, Busse WW, Holgate AT, Lemanske RF, O'Hehir RE Editors. Middleton's Allergy, Principles and Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:664-685. https://doi.org/10.1016/B978-0-323-08593-9.00043-7

Gómez M. Epidemiología del asma en Argentina. Arch Aler Inmunol Clin 2006;37(2):63-70.

Barlow JL, McKenzie AN. Type-2 innate lymphoid cells in human allergic disease. Curr Opin Allergy Clin Immunol. 2014 Oct;14(5):397-403. https://doi.org/10.1097/ACI.0000000000000090

Higgins TS, Reh DD. Environmental pollutants and allergic rhinitis. Curr Opin Otolaryngol Head Neck Surg. 2012 Jun;20(3):209-14. https://doi.org/10.1097/MOO.0b013e3283534821

Hernández ML, Peden DB. Air Pollution: Indoor and Outdoor. En: Adkinson NF, Bochner BS, Burks AW, Busse WW, Holgate AT, Lemanske RF, O'Hehir RE Editors. Middleton's Allergy, Principles and Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:482-496.

Nandasena S, Wickremasinghe AR, Sathiakumar N. Indoor air pollution and respiratory health of children in the developing world. World J Clin Pediatr 2013 May 8; 2(2): 6-15. https://doi.org/10.5409/wjcp.v2.i2.6

Williams LK, Ownby DR, Maliarik MJ, Johnson CC. The role of endotoxin and its receptors in allergic disease. Ann Allergy Asthma Immunol. 2005 Mar;94(3):323-32. https://doi.org/10.1016/S1081-1206(10)60983-0

Meyers DG, Neuberger JS, He J. Cardiovascular effect of bans on smoking in public places: a systematic review and mate-analysis. J Am Coll Cardiol. 2009 Sep 29;54(14):1249-55. https://doi.org/10.1016/j.jacc.2009.07.022

Wolf P, D'Agostino R, Kannel W, et al: Cigarette smoking as a risk factor for stroke: the Framingham Study. JAMA. 1988 Feb 19;259(7):1025-9. https://doi.org/10.1001/jama.1988.03720070025028

Parsons A, Daley A, Begh R, Aveyard P. Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. BMJ. 2010 Jan;340:b5569. https://doi.org/10.1136/bmj.b5569

St-Lauren J, Bergeron C, Pagé N, Couture C, Laviolette M, Boulet LP. Influence of smoking on airway inflammation and remodeling in asthma. Clin Exp Allergy. 2008 Oct;38(10):1582-9. https://doi.org/10.1111/j.1365-2222.2008.03032.x

Polosa R, Knoke JD, Russo C, Piccillo G, Caponnetto P, Sarvá M et al. Cigarette smoking is associated with a greater risk of incident asthma in allergic rhinitis. J Allergy Clin Immunol. 2008 Jun;121(6):1428-34. https://doi.org/10.1016/j.jaci.2008.02.041

Hadar T1, Yaniv E, Shvili Y, Koren R, Shvero J. Histopathological changes of the nasal mucosa induced by smoking. Inhal Toxicol. 2009 Nov;21(13):1119-22. https://doi.org/10.3109/08958370902767070

Jaspers I. Cigarette smoke effects on innate immune mechanisms in the nasal mucosa. Potential effects on the microbiome. Ann Am Thorac Soc. 2014 Jan;11 Suppl 1:S38-42. https://doi.org/10.1513/AnnalsATS.201306-154MG

Tanou K, Koutsokera A, Kiropoulos TS, Maniati M, Papaioannou AI, Georga K, Zarogiannis S, Gourgoulianis KI, Kostikas K. Inflammatory and oxidative stress biomarkers in allergic rhinitis: the effect of smoking. Clin Exp Allergy. 2009 Mar;39(3):345-53. https://doi.org/10.1111/j.1365-2222.2008.03149.x

Mishra NC, Rir-sima-ah J, Langley RJ, Singh SP, Peña-Philippides JC, Koga T, Razani-Boroujerdi S, Hutt J, Campen M, Kim KC, Tesfaigzi Y, Sopori ML. Nicotine Primarily Suppresses Lung Th2 but Not Goblet Cell and Muscle Cell Responses to Allergens. J Immunol. 2008 June; 180(11): 7655-7663. https://doi.org/10.4049/jimmunol.180.11.7655

Bousquet PJ, Cropet C, Klossek JM, Allaf B, Neukirch F, Bousquet J. Effect of smoking on symptoms of allergic rhinitis. Ann Allergy Asthma Immunol. 2009 Sep;103(3):195-200. https://doi.org/10.1016/S1081-1206(10)60181-0

Ciaccio CE, DiDonna AC, Kennedy K, Barnes CS, Portnoy JM, Rosenwasser LJ. Association of tobacco smoke exposure and atopic sensitization. Ann Allergy Asthma Immunol. 2013 Nov;111(5):387-90. https://doi.org/10.1016/j.anai.2013.07.023

Feleszko W, Ruszczyński M, Jaworska J, Strzelak A, Zalewski BM, Kulus M. Environmental tobacco smoke exposure and risk of allergic sensitisation 42 in children: a systematic review and meta-analysis. Arch Dis Child. 2014 Nov;99(11):985-92. https://doi.org/10.1136/archdischild-2013-305444

Baena-Cagnani CE, Gómez RM, Baena-Cagnani R, Canonica GW. Impact of environmental tobacco smoke and active tobacco smoking on the development and outcomes of asthma and rhinitis. Curr Opin Allergy Clin Immunol. 2009 Apr;9(2):136-40. https://doi.org/10.1097/ACI.0b013e3283294038

Annesi Maesano I, Oryszczyn MP, Raherison C, Kopferschmitt C, Pauli G, Taytard A, Tunon de Lara M, Vervloet D, Charpin D. Increased prevalence of asthma and allied diseases among active adolescent tobacco smokers after controlling for passive smoking exposure. A cause for concern? Clin Exp Allergy. 2004 Jul;34(7):1017-23. https://doi.org/10.1111/j.1365-2222.2004.02002.x

Gómez M, Vollmer WM, Caceres ME, Jossen R, Baena-Cagnani CE. Adolescent smokers are at greater risk for current asthma and rhinitis. Int J Tuberc Lung Dis. 2009 Aug;13(8):1023-8.

Vartiainen E, Seppala T, Lillsunde P, Puska P. Validation of self reported smoking by serum cotinine measurement in a community-based study. J Epidemiol Community Health. 2002 Mar;56(3): 167-70. https://doi.org/10.1136/jech.56.3.167

Connor Gorber S, Schofield-Hurwitz S, Hardt J, Levasseur G, Tremblay M. The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res. 2009 Jan;11(1):12-24. https://doi.org/10.1093/ntr/ntn010

Langone JJ, Cook G, Biercke RJ, Lifschitz MH. Monoclonal antibody ELISA for cotinine in saliva and urine of active and passive smokers. J Immunol Methods. 1988 Nov 10;114(1-2):73-8. https://doi.org/10.1016/0022-1759(88)90156-1

van Vunakis H, Tashkin DP, Rigas B, Simmons M, Gjika HB, Clark VA. Relative sensitivity and specificity of salivary and serum cotinine in identifying tobacco-smoking status of self-reported nonsmokers and smokers of tobacco and/or marijuana. Arch Environ Health. 1989 JanFeb;44(1):53-8. https://doi.org/10.1080/00039896.1989.9935873

Juniper EF, Thompson AK, Ferrie PJ, Roberts JN. Development and validation of the mini Rhinoconjunctivitis Quality of Life Questionnaire. Clin Exp Allergy. 2000 Jan;30(1):132-40. https://doi.org/10.1046/j.1365-2222.2000.00668.x

Fuiano N, Incorvaia C. Dissecting the causes of atopic dermatitis in children: less foods, more mites. Allergol Int. 2012 Jun;61(2):231-43. https://doi.org/10.2332/allergolint.11-RA-0371

Lindberg RE, Arroyave C. Levels of IgE in serum from normal children and allergic children as measured by an enzyme immunoassay. J Allergy Clin Immunol. 1986 Oct;78(4 Pt 1):614-8. https://doi.org/10.1016/0091-6749(86)90078-3

De Schryver E, Devuyst L, Derycke L, Dullaers M, Van Zele T, Bachert C, Gevaert P. Local immunoglobulin e in the nasal mucosa: clinical implications. Allergy Asthma Immunol Res. 2015 Jul;7(4):321-31. https://doi.org/10.4168/aair.2015.7.4.321

Rondón C, Campo P, Togias A, Fokkens WJ, Durham SR, Powe DG, Mullol J, Blanca M. Local allergic rhinitis: concept, pathophysiology, and management. J Allergy Clin Immunol. 2012 Jun;129(6):1460-7. https://doi.org/10.1016/j.jaci.2012.02.032

Carr TF, Saltoun CA. Chapter 2: Skin testing in allergy. Allergy Asthma Proc. 2012 May-Jun;33 Suppl 1:S6-8. https://doi.org/10.2500/aap.2012.33.3532

Oppenheimer J, Nelson HS. Skin testing. Ann Allergy Asthma Immunol. 2006 Feb;96(2 Suppl 1):S6-12. https://doi.org/10.1016/S1081-1206(10)60895-2

Croce V H. Tesis de Doctorado. 1988. Universidad Católica de Córdoba. RA. "Histopatología de la mucosa nasal en la rinitis alérgica".

Romagnani S. T-cell subsets (Th1 versus Th2). Ann Allergy Asthma Immunol. 2000 Jul;85(1):9-18; quiz 18, 21. https://doi.org/10.1016/S1081-1206(10)62426-X

Klemens C, Rasp G, Jund F, Hilgert E, Devens C, Pfrogner E, Kramer MF. Mediators and cytokines in allergic and viral-triggered rhinitis. Allergy Asthma Proc. 2007 Jul-Aug;28(4):434-41. https://doi.org/10.2500/aap.2007.28.3017

Ciprandi G, De Amici M, Murdaca G, Fenoglio D, Ricciardolo F, Marseglia G, Tosca M. Serum interleukin-17 levels are related to clinical severity in allergic rhinitis. Allergy. 2009 Sep;64(9):1375-8. 44 https://doi.org/10.1111/j.1398-9995.2009.02010.x

Huang X, Chen Y, Zhang F, Yang Q, Zhang G. Peripheral Th17/Treg cellmediated immunity imbalance in allergic rhinitis patients. Braz J Otorhinolaryngol. 2014 Apr;80(2):152-5. https://doi.org/10.5935/1808-8694.20140031

Rogala B, Glück J. The role of interleukin-33 in rhinitis. Curr Allergy Asthma Rep. 2013 Apr;13(2):196-202. https://doi.org/10.1007/s11882-013-0338-z

Nakanishi W, Yamaguchi S, Matsuda A, Suzukawa M, Shibui A, et al. (2013) IL-33, but Not IL-25, Is Crucial for the Development of House Dust Mite Antigen-Induced Allergic Rhinitis. PLoS ONE 8(10): e78099. https://doi.org/10.1371/journal.pone.0078099

Asaka D, Yoshikawa M, Nakayama T, Yoshimura T, Moriyama H, Otori N. Elevated levels of interleukin-33 in the nasal secretions of patients with allergic rhinitis. Int Arch Allergy Immunol. 2012;158 Suppl 1:47-50. https://doi.org/10.1159/000337764

Fay MP, Proschan MA. Wilcoxon-Mann-Whitney or t-test? On assumptions for hypothesis tests and multiple interpretations of decision rules. Stat Surv. 2010;4:1-39. https://doi.org/10.1214/09-SS051

Bouloukaki I, Tsiligianni IG, Tsoumakidou M, Mitrouska I, Prokopakis EP, Mavroudi I, Siafakas NM, Tzanakis N. Sputum and nasal lavage lungspecific biomarkers before and after smoking cessation. BMC Pulm Med. 2011 Jun 2;11:35. https://doi.org/10.1186/1471-2466-11-35

Miller MR1, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J; ATS/ERS Task Force. General considerations for lung function testing. Eur Respir J. 2005 Jul;26(1):153-61. https://doi.org/10.1183/09031936.05.00034505

Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ et al. Practical guide to skin prick tests in allergy to aeroallergens. Position Paper. Allergy. 2012 Jan;67(1):18-24. https://doi.org/10.1111/j.1398-9995.2012.02772.x

Hur K1, Liang J, Lin SY. The role of secondhand smoke in allergic rhinitis: a systematic review. Int Forum Allergy Rhinol. 2014 Feb;4(2):110-6. https://doi.org/10.1002/alr.21246

Skoner DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol. 2001 Jul;108(1 Suppl):S2- 8. https://doi.org/10.1067/mai.2001.115569

Sarinho E, Cruz AA. Anti-IgE monoclonal antibody for the treatment of the asthma and other manifestations related to allergic diseases. J Pediatr (Rio J). 2006 Nov;82(5 Suppl):S127-32. https://doi.org/10.1590/S0021-75572006000700002

Baena-Cagnani CE, Gómez RM. Current status of therapy with omalizumab in children. Curr Opin Allergy Clin Immunol. 2014 Apr;14(2):149-54. https://doi.org/10.1097/ACI.0000000000000044

Bonsignore MR, Profita M, Gagliardo R, Riccobono L, Chiappara G, Pace E, Gjomarkaj M. Advances in asthma pathophysiology: stepping forward from the Maurizio Vignola experience. Eur Respir Rev. 2015 Mar;24(135):30-9. https://doi.org/10.1183/09059180.10011114

Joseph J, Benedict S, Safa W, Joseph M. Serum interleukin-5 levels are elevated in mild and moderate persistent asthma irrespective of regular inhaled glucocorticoid therapy. BMC Pulm Med. 2004 Mar 17;4:2. https://doi.org/10.1186/1471-2466-4-2

Scadding G. Cytokine profiles in allergic rhinitis. Curr Allergy Asthma Rep. 2014 May;14(5):435. https://doi.org/10.1007/s11882-014-0435-7

Sorbello V, Ciprandi G, Di Stefano A, Massaglia GM, Favatà G, Conticello S, Malerba M, Folkerts G, Profita M, Rolla G, Ricciardolo FL. Nasal IL-17F is related to bronchial IL-17F/neutrophilia and exacerbations in stable atopic severe asthma. Allergy. 2015 Feb;70(2):236-40. https://doi.org/10.1111/all.12547

Firszt R, Francisco D, Church TD, Thomas JM, Ingram JL, Kraft M. Interleukin-13 induces collagen type-1 expression through matrix metalloproteinase-2 and transforming growth factor-β1 in airway fibroblasts in asthma. Eur Respir J. 2014 Feb;43(2):464-73. https://doi.org/10.1183/09031936.00068712

Watelet JB, Van Zele T, Gjomarkaj M, Canonica GW, Dahlen SE, Fokkens W, Lund VJ, Scadding GK, Mullol J, Papadopoulos N, Bonini S, Kowalski ML, Van Cauwenberge P, Bousquet J; GA(2)LEN Workpackage Members 2.7. Tissue remodelling in upper airways: where is the link with lower airway remodelling? Allergy. 2006 Nov;61(11):1249-58. https://doi.org/10.1111/j.1398-9995.2006.01226.x

Raulf M, Buters J, Chapman M, Cecchi L, de Blay T, Doekes G, Eduard W, Heederik D, Jeebhay MB, Kespohl S, Krop E, Moscato G, Pala G, Quirce S, Sander I, Schleunssen E, Sigsgaard T, Walusiak-Skorupa J, Wiszniewska M, Wouters IM, Annesi-Maesano I. Monitoring of occupational and environmental aeroallergens - EAACI Position Paper Concerted action of the EAACI IG Occupational Allergy and Aerobiology & Air Pollution. Allergy. 2014 Oct;69(10):1280-99. https://doi.org/10.1111/all.12456

Pagliuca G, Rosato C, Martellucci S, de Vincentiis M, Greco A, Fusconi M, De Virgilio A, Gallipoli C, Simonelli M, Gallo A. Cytologic and functional alterations of nasal mucosa in smokers: temporary or permanent damage? Otolaryngol Head Neck Surg. 2015 Apr;152(4):740-5. https://doi.org/10.1177/0194599814566598

Lei Y, Boinapally V, Zoltowska A, Adner M, Hellman L, Nilsson G. Vaccination against IL-33 Inhibits Airway Hyperresponsiveness and Inflammation in a House Dust Mite Model of Asthma. PLoS One. 2015 Jul 27;10(7):e0133774. https://doi.org/10.1371/journal.pone.0133774

Saluja R, Khan M, Church MK, Maurer M. The role of IL-33 and mast cells in allergy and inflammation. Clin Transl Allergy. 2015 Sep 29;5:33. https://doi.org/10.1186/s13601-015-0076-5

Nizri E, Ironytursinai M, Lory O, Orrurtreger A, Lavi E, Brenner T. Activation of the Cholinergic Anti-Inflammatory System by Nicotine Attenuates Neuroinflammation via Suppression of Th1 and Th17 Responses. J Immunol. 2009 Nov 15;183(10):6681-8. https://doi.org/10.4049/jimmunol.0902212

Ohshimo S, Bonella F, Guzman J, Costabel U. Hypersensitivity Pneumonitis. Immunol Allergy Clin North Am. 2012 Nov;32(4):537-56. https://doi.org/10.1016/j.iac.2012.08.008

Canonica GW, Tarantini F, Compalati E, Penagos M. Efficacy of desloratadine in the treatment of allergic rhinitis: a meta-analysis of randomized, double-blind, controlled trials. Allergy. 2007 Apr;62(4):359-66. https://doi.org/10.1111/j.1398-9995.2006.01277.x

Ciprandi G, Cirillo I, Vizzaccaro A, Civardi E, Barberi S, Allen M, Marseglia GL. Desloratadine and levocetirizine improve nasal symptoms, airflow, and allergic inflammation in patients with perennial allergic rhinitis: a pilot study. Int Immunopharmacol. 2005 Dec;5(13-14):1800-8. https://doi.org/10.1016/j.intimp.2005.05.008

Juniper EF, Thompson AK, Ferrie PJ, Roberts JN. Validation of the standardized version of the Rhinoconjunctivitis Quality of Life Questionnaire. J Allergy Clin Immunol. 1999 Aug;104(2 Pt 1):364-9. https://doi.org/10.1016/S0091-6749(99)70380-5

Díaz Sánchez D, Rumold R, Gong HJr. Challenge with environmental tobacco smoke exacerbates allergic airway disease in human beings. J Allergy Clin Immunol. 2006 Aug;118(2):441-6. https://doi.org/10.1016/j.jaci.2006.04.047

Publicado

2016-11-14

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Tesis Doctorales

Cómo citar

Gómez, R. M. (2016). El consumo de tabaco empeora la inflamación nasal y la calidad de vida en pacientes con rinitis alérgica. Methodo Investigación Aplicada a Las Ciencias Biológicas, 1(1). https://revistas.bibdigital.uccor.edu.ar/index.php/method/article/view/1373