Quantitative Cytology of Nasal Secretions With Perennial Allergic Rhinitis in Children: Comparison of Noninfected and Infected Conditions

This study was performed to quantify the number of inflammatory cells in nasal secretions from pediatric patients with perennial allergic rhinitis under noninfected and infected conditions. Nasal secretions were obtained from seven children under both noninfected and infected conditions with perennial allergic rhinitis to house dust mites, and secondary quantitative cytology was performed on the secretions. The number of neutrophils under infected condition was significantly higher than that under noninfected condition (P < .05), whereas the number of eosinophils in infected condition was significantly lower than that in noninfected condition (P < .05). The ratio of eosinophil count to neutrophil count was more than 0.1 in noninfected condition. The ratio was significantly decreased in infected condition (P < .02). These results suggest that the distribution of inflammatory cells in the nasal mucus of children with allergic rhinitis would be modified under infected condition.     

变应性因素对鼻内镜手术疗效的影响

目的：探讨变应性因素对慢性鼻窦炎伴鼻息肉患者行鼻窦内窥镜手术疗效的影响。方法对我院2011～2012年入院手术的II型慢性鼻窦炎伴鼻息肉患者,术前根据其是否伴有变应性鼻炎症状和体征、是否伴有过敏性疾病史及支气管哮喘病史、术前鼻腔分泌物涂片嗜酸粒细胞检查、变应原皮肤试验、血清特异性IgE检查、过敏性鼻炎,筛选出伴有变应性因素的慢性鼻窦炎伴鼻息肉患者为试验组。选择同期无变应性因素的单纯慢性鼻窦炎伴鼻息肉患者作为对照组。比较两组患者手术后疗效,并同时比较各种变应性因素对手术疗效的影响。结果伴有变应性因素的慢性鼻窦炎伴鼻息肉患者,手术疗效为80.95%（136/168）,同期单纯慢性鼻窦炎伴鼻息肉患者,手术疗效为91.75%（189/206）,两组间差异有显著性（P〈0.01）。在各种变应性因素中,伴有变应性鼻炎症状和体征、嗜酸粒细胞阳性、变应原皮肤试验阳性、血清特异性IgE、过敏性鼻炎的慢性鼻窦炎伴鼻息肉患者,与无变应性因素的慢性鼻窦炎伴鼻息肉患者比较,差异均有显著性（P〈0.05）,伴有过敏性疾病史及伴支气管哮喘病史患者与无变应性因素的慢性鼻窦炎伴鼻息肉患者比较,差异无显著性（P〉0.05）。结论变应性因素与鼻窦内窥镜手术疗效密切相关,是术后复发的重要因素。对慢性鼻窦炎伴鼻息肉患者行鼻窦内窥镜手术时,必须加强围手术期抗变应性治疗。     

慢性鼻窦炎鼻息肉与变应性因素相关性的探讨

目的 探讨变应性因素在慢性鼻窦炎鼻息肉发病中的作用。方法回顾性分析1882例慢性鼻窦炎鼻息肉患者术前鼻腔分泌物涂片嗜酸粒细胞及变应原皮肤试验检查结果，并将其变应性症状和体征出现的比例与临床分型分期加以比较。结果①1882例慢性鼻窦炎鼻息肉患者中60．4％(1137例)的患者伴有不同程度的变应性症状和体征，25．3％(477例)的患者合并变应性鼻炎，2．1％(39例)的患者合并支气管哮喘；②在Ⅰ型(708例)和Ⅱ型(823例)各分期的患者中，合并变应性鼻炎及支气管哮喘的发生率和嗜酸粒细胞、皮肤变应原试验阳性率以及变应性鼻炎临床症状出现的百分率分别由低到高出现，Ⅱ型3期各项比例最高；③42．2％(795例)的患者变应原皮肤试验阳性，其中94．3％对常年性变应原呈阳性反应；④26．3％(495例)的患者伴有变应性鼻炎的临床症状，其中99．8％(494／495例)为常年性发作；⑤有前期手术史的病例占38．9％(732例)，其中合并变应性鼻炎者占有前期手术史例数的38．3％(280例)，占合并变应性鼻炎患者的58．7％(477例)。结论变应性因素特别是常年性变应性鼻炎与慢性鼻窦炎鼻息肉的病变程度和病变范围有关。同时变应性鼻炎也促进了疾病的复发。     

A prospective study of bacterial flora in nasal cavity of patients with persistent allergic rhinitis

It remains unanswered whether persistent allergic inflammation in nasal mucosa alters bacterial colonization and infection. The aim of this study was to investigate the bacterial flora in the nasal cavity of patients with persistent allergic rhinitis (PAR) and to correlate the bacteriological findings with presence of nasal symptoms, nasal eosinophil and neutrophil counts. A total of 255 subjects, aged between 6 - 74 years (mean 33.9 years) was randomly selected from a population-based rhinitis survey study in Singapore. All subjects went through a thorough medical history and nasal examinations. Serum specific IgE to a panel of common house dust mites, nasal cytological and microbiological examinations were performed. PAR was diagnosed in 107 patients and none of them had received previous regular therapy. There is a significant relationship between PAR and eosinophil grades, but not with neutrophil count. No statistically significant difference was found in quantitative and qualitative bacterial flora in nasal cavity between PAR patients and subjects with non-rhinitis or with non-allergic rhinitis. There is a significant inverse correlation between ongoing rhinorrhoea and quantitative bacterial load, and between signs of nasal mucosa (pale and edema) and the presence and type of bacterial pathogens. In conclusion, our study demonstrates that patients with untreated (or using PRN medicine) PAR do not result in a significant change in bacterial flora in their nasal cavity.     

Nasal interleukin-5, immunoglobulin E, eosinophilic cationic protein, and soluble intercellular adhesion molecule-1 in chronic sinusitis, allergic rhinitis, and nasal polyposis

OBJECTIVE: To compare concentrations of interleukin-5 (IL-5), immunoglobulin E (IgE), eosinophilic cationic protein (ECP), and soluble intercellular adhesion molecule-1 (sICAM-1) in nasal secretion and serum of patients with chronic nonallergic sinusitis, allergic rhinitis, and nonallergic nasal polyposis to obtain information about the pathogenesis of these diseases. METHODS: Nasal secretion and serum were analyzed by routine enzyme-linked immunosorbent assay techniques. Nineteen patients with chronic nonallergic sinusitis, 24 patients with seasonal allergic rhinitis, and 18 patients with nonallergic nasal polyposis were included in the study. Eight healthy, nonallergic probands served as control subjects. RESULTS: Significantly elevated concentrations of IL-5 (5-fold, P < .05) and IgE (15-fold, P < .01) were detected in nasal secretion of patients with allergic rhinitis (IL-5, 51.8 +/- 13.2 pg/mL; IgE, 41.9 +/- 20.9 kU/L) or nonallergic nasal polyposis (IL-5, 57.9 +/- 36.9 pg(mL; IgE, 40.5 +/- 20.2 kU/L) compared with controls (IL-5, 10.6 +/- 7.8 pg/mL; IgE, 2.8 +/- 0.5 kU/L) or with patients with chronic nonallergic sinusitis (IL-5, 16.5 +/- 13.2 pg/mL; IgE, 5.4 +/- 3.1 kU/L). There were no significant differences between patients with allergic rhinitis and those with nonallergic nasal polyposis. Concentrations of ECP were significantly elevated (sixfold, P < .01) in patients with allergic rhinitis (297.8 ng/mL +/- 173.1) compared with controls (52.4 +/- 28.0 ng/mL) or patients with chronic nonallergic sinusitis (44.8 +/- 40.1 ng/mL), whereas twofold higher concentrations (not significant) of ECP were observed in patients with nonallergic nasal polyposis (107.1 +/- 26.6 ng/mL). Significantly elevated concentrations of sICAM-1 in nasal secretion (threefold, P < .05) were detected only in patients with chronic nonallergic sinusitis (79.4 +/- 45.6 ng/mL). The elevated sICAM-1 nasal secretion values in this group correlated significantly (P < .05) to the serum values. CONCLUSIONS: Equally elevated concentrations of IL-5 and IgE in patients with allergic rhinitis and nonallergic nasal polyposis implicated similar pathogenic processes in both diseases. Whereas the pathogenesis of allergic rhinitis is IgE-specific, the pathogenesis of nasal polyps is not as clear. IL-5 was suggested to play a pivotal role in tissue eosinophilia, which was confirmed by data in the present study. Elevated concentrations of ECP were suggested to result from tissue eosinophilia--a characteristic of both diseases. Elevated concentrations of sICAM-1 in patients with chronic nonallergic sinusitis pointed to its key role in the recruitment of neutrophils into the inflamed tissue, whereas an important role in eosinophil recruitment was ruled out.     

Decongestion test in patients with allergic rhinitis: functional evaluation of nasal airflow

BACKGROUND: Rhinomanometry measures nasal airflow that is frequently impaired in allergic rhinitis. Decongestion tests consist of spraying an intranasal vasoconstrictor drug to evaluate the reversibility of nasal airflow limitation. The aim of this study was to evaluate the decongestion test in patients with seasonal allergic rhinitis (SAR) caused by pollen sensitization, perennial allergic rhinitis (PAR) caused by sensitization to perennial allergens only, or mixed allergic rhinitis (MAR) caused by sensitization to both allergens. METHODS: One hundred twenty-three subjects (112 men and 11 women, mean age, 22.9 +/- 5.7 years) were studied; 40 subjects had PAR, 43 subjects had MAR, and 40 subjects had SAR. Total symptom score (including: nasal itching, sneezing, rhinorrhea, and nasal obstruction) was assessed. Rhinomanometry and decongestion tests were performed in all subjects. RESULTS: Nasal symptom severity was superimposable in the three groups (p was not significant). After decongestion tests, an increase of nasal airflow and a decrease of nasal resistance was shown in PAR (p < 0.01), MAR (p < 0.001), and SAR subjects (p < 0.001). The intergroup analysis showed that SAR patients had less reversibility than PAR (p < 0.01). CONCLUSION: This study provides the first evidence of the different response to decongestion tests, taking into consideration the causal allergens.     

变应性鼻炎鼻分泌物中上皮细胞集落和嗜酸粒细胞的检测

为了观察变应性鼻炎（allesgicrhinitis，AR）患者鼻分泌物中的上皮细胞集落和嗜酸粒细胞，对20例AR患者（AR组）和15例鼻窦炎患者（感染组）鼻分泌物中细胞成分进行了电镜观察，发现AR组鼻分泌物中有大量上皮细胞集落，其特征是数个至数十个上皮细胞成片状脱落，上皮细胞集落的数量和嗜酸粒细胞的数量、嗜酸粒细胞阳离子蛋白（eosinophiliccationicprotein，ECP）的含量呈正相关。感染组中上皮细胞集落和嗜酸粒细胞极少，ECP含量甚微。结果提示嗜酸粒细胞的ECP可能导致AR患者的鼻粘膜上皮呈片状脱落，对上皮结构造成损害。     

Nasal brushing: a clinically useful procedure in pediatric patients with rhinosinusitis?

Sinusitis is a common complication of non-allergic and allergic rhinitis, and can trigger lower respiratory diseases, such as bronchitis and asthma. Standard radiography is unable to give any data about the underlying pathological mechanisms (infectious or allergic) involved and infectious rhinosinusitis is very common in pediatric age, even in allergic patients. We investigated the possibility of obtaining more useful diagnostic information, performing nasal brushing (NB) on 117 children with recurrent respiratory symptoms. The following hypothesis were evaluated: (1) whether NB neutrophil/eosinophil percentages and/or NB culture could predict the radiological evidence of maxillary sinusitis; and (2) whether differences between nonallergic and allergic patients could be detected. In the total patient group and in the nonallergic group, the comparison of NB neutrophil percentages in patients with and without maxillary sinusitis showed a statistically significant difference (median 2 and 18%, respectively; P < 0.001). In the nonallergic group, a NB neutrophil rate > or = 5% was chosen as a cut-off between positive and negative NB diagnosis of rhinosinusitis and NB data were compared with radiological investigations. The results obtained showed that NB was fairly sensitive (91%) and predictive (84%). In allergic patients, neither neutrophil nor eosinophil percentages significantly correlated with the presence of sinusitis. Microbiological studies showed that, even if the presence of bacteria in NB resulted associated with sinusitis, a negative culture was not predictive of the absence of the disease. We therefore suggest that NB describes the present inflammatory status of the upper airways, hence, it is more suitable to describe the inflammation related to ongoing upper respiratory tract infections rather than chronic inflammation due to allergic rhinitis, characterized by relapsing episodes of acute inflammation. In conclusion, we propose to consider NB a reliable tool in the diagnosis of rhinosinusitis, particularly in nonallergic pediatric patients. Compared to standard radiological techniques, NB makes it possible to avoid radiation exposure and gives information about the pathological mechanisms involved in the single patient.     

The role of the eosinophil in nasal diseases

PURPOSE OF REVIEW: The eosinophil is involved in physiologic and pathologic processes, such as asthma, parasitic diseases, granulomatous disorders, fibrosis, malignant tumors and several sino-nasal diseases. RECENT DEVELOPMENTS: Recent data on the structure and function of the eosinophil provides additional information regarding the pathophysiology and the treatment options of these diseases. In this paper the most recently acquired data on the role of the eosinophil in allergic rhinitis (with or without bronchial asthma), chronic sinusitis (with or without nasal polyposis) and allergic fungal sinusitis are reviewed. SUMMARY: The data provides evidence regarding the pivotal role of the eosinophil in sino-nasal diseases. Possible ways to target the eosinophils are discussed.     

Vascular endothelial growth factor produced in nasal glands of perennial allergic rhinitis

BACKGROUND: Vascular endothelial growth factor (VEGF), a pleiotropic polypeptide that mediates endothelial cell-specific responses such as induction of angiogenesis and vascular leakage, is hyperproduced in a variety of inflammatory disorders. In asthma, VEGF hyperproduction promotes mucosal edema by enhancing vascular leakage. However, in allergic rhinitis, details of the pathophysiological importance remain unclear. This study was designed to investigate and discuss the pathophysiological significance of VEGF in nasal secretions from perennial allergic rhinitis sufferers. METHODS: Seven allergic rhinitis patients sensitized with house-dust mites and 12 chronic rhinosinusitis patients were enrolled. Nasal secretion VEGF was quantified and compared between groups. In allergic rhinitis cases, nasal lavage VEGF was estimated before and after the antigen provocation. Nasal gland VEGF was immunohistochemically investigated. VEGF messenger RNA (mRNA) levels in serous and mucous acini were analyzed by laser microdissection and light cycler-polymerase chain reaction. RESULTS: VEGF levels in nasal secretions and nasal lavage from allergic rhinitis were higher than in nonallergic rhinosinusitis, after rather than before antigen provocation. VEGF mRNA expression was higher in serous versus mucous acini. These results are consistent with the immunohistochemistry results. CONCLUSION: In allergic rhinitis, there was significant VEGF production in serous acini, which was hypersecreted after antigen provocation. VEGF may play an important role in pathophysiology of allergic rhinitis.     

A protease inhibitor from human allergic nasal secretions

Protease and antiprotease activities were estimated in nasal secretions from patients with chronic sinusitis and nasal allergy, using [3H]-casein as substrate. In the purulent nasal secretions, strong protease activity was measured, but there was less activity in the allergic nasal secretions. In contrast, trypsin inhibitory activity in allergic nasal secretions was much higher than in nasal secretions from the patients with chronic sinusitis. A protease inhibitor was partially isolated from nasal secretions of the nasal allergic patients by Sephadex G-150 gel chromatography and characterized. This protease inhibitor has an apparent molecular weight of 10,000 D, determined by SDS-polyacrylamidegel electrophoresis. It depresses the activities of bovine pancreatic trypsin, bovine pancreatic chymotrypsin and proteases in nasal purulent secretions, whereas it does not inhibit porcine pancreatic elastase, papain, or human plasmin.     

变应性因素及变应性鼻炎与慢性鼻-鼻窦炎鼻息肉的相关性探讨

目的：探讨变应性因素及变应性鼻炎（AR）与慢性鼻-鼻窦炎鼻息肉的临床相关性。方法：将200例研究对象分为A、B组,A组诊断为AR（110例）,B组诊断为慢性鼻-鼻窦炎鼻息肉（90例）,通过欧蒙印迹法定量检测血清sIgE浓度并观察慢性鼻-鼻窦炎鼻息肉手术治疗后的复发率、AR并发慢性鼻-鼻窦炎鼻息肉的发生率。结果：A组sIgE总阳性率为89.09%,B组sIgE总阳性率为74.44%。B组中sIgE阳性者术后复发率为58.21%,sIgE阴性者术后复发率为8.70%。A组41例（37.27%）并发慢性鼻-鼻窦炎鼻息肉,血清sIgE阳性率为97.56%;69例（62.73%）未并发慢性鼻-鼻窦炎鼻息肉,血清sIgE阳性率为79.71%;组内slgE阳性率比较差异有统计学意义（χ2=6.96,P〈0.01）。结论：变应性因素及AR与慢性鼻-鼻窦炎鼻息肉的发生有一定的相关性,提示避免接触变应原、合理治疗AR能够有效控制慢性鼻-鼻窦炎鼻息肉的复发率。     

鼻息肉患者鼻息肉组织及鼻分泌物中白细胞介素-5的测定

目的 :探讨鼻息肉患者鼻息肉组织及鼻分泌物中白细胞介素 - 5 (IL- 5 )的含量。方法 :采用双抗体夹心酶联免疫吸附法 (EL ISA)测定鼻分泌物及组织匀浆中 IL- 5含量 ,用 Bradford法测定组织匀浆总蛋白 ,研究对象为 :31例鼻息肉患者 ,8例常年性变应性鼻炎 ,11例慢性鼻窦炎及 6例健康人对照。结果 :1鼻息肉患者鼻息肉组织 IL- 5水平高于慢性鼻窦炎及健康人 (P <0 .0 0 1) ;2鼻息肉患者与常年性变应性鼻炎患者鼻分泌物中 IL- 5水平均明显增高 ,其与慢性鼻窦炎及健康人比较 ,差异有显著意义 (P <0 .0 5 ) ;3在整体水平上 (5 6例 )和鼻息肉组内 (31例 )组织匀浆与鼻分泌物中 IL- 5含量的 Pearson相关系数分别为 0 .70和 0 .6 6。结论 :鼻息肉匀浆组织及鼻分泌物中 IL- 5含量明显升高 ,提示 IL-5与鼻息肉有密切的关系 ,在鼻息肉的发病中起着较为关键的作用。     

Cyclic nucleotide levels of nasal secretions in allergic patients and control subjects

Cyclic nucleotides (CND) levels of nasal secretions were studied in allergic rhinitis patients and control subjects. In methacholine-induced nasal secretion, allergic rhinitis patients had lower cAMP levels, higher cGMP levels and a lower cAMP/cGMP ratio than the control subjects. A close relationship was found between CND levels and the severity of daily symptoms in both methacholine-induced and antigen-induced nasal secretions.     

Immunologic aspects of ozena

Summary Cyclic nucleotides (CND) levels of nasal secretions were studied in allergic rhinitis patients and control subjects. In methacholine-induced nasal secretion, allergic rhinitis patients had lower cAMP levels, higher cGMP levels and a lower cAMP/cGMP ratio than the control subjects. A close relationship was found between CND levels and the severity of daily symptoms in both methacholine-induced and antigen-induced nasal secretions.     

Lysosomal proteases and protease inhibitors in nasal allergy and non-atopic sinusitis

Patterns of protease activity and levels of protease inhibitors were analyzed in both nasal secretions and tissue extracts from patients with nasal allergy and non-atopic sinusitis to investigate the role of proteases in the inflammatory reaction. Protease activity was measured using specific methyl-coumaryl-7-amide substrates. The pattern of protease activity in the nasal secretions of chronic sinusitis patients was similar to that in neutrophil lysate and quite different from that in plasma. Both gluthatione activation testing and inhibition testing using synthetic inhibitors revealed that the majority of proteases in both secretions and tissues are lysosomal thiol proteases such as cathepsins B and L. Neutrophilic elastase is also a major protease in nasal secretions. In acute sinusitis, both protease activity and inhibitor levels were very high, suggesting an interaction between proteases and inhibitors. Cathepsin B and B-like thiol proteases appear to play a key role in prolonging chronic inflammation against the healing process, due to their resistance to plasma inhibitors and the shortage of thiol protease inhibitors. Protease activity in the secretions of nasal allergy patients was very weak, and the reaction between proteases and inhibitors appeared to be weak.     

Chronic rhinosinusitis: is the nose really involved?

To determine whether chronic rhinitis usually accompanies chronic sinusitis, and critically examine the concept of chronic rhinosinusitis, paired specimens of nasal septal mucosa and ethmoid sinus mucosa were obtained in a prospective cohort of 42 patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. The histopathological degree of inflammation for each specimen was scored using a five-point rating scale. Cell counts for eosinophils and inflammatory cells per high-power field (HPF) were determined. Mean patient age was 40.5 years and mean Lund score was 9.3. The inflammation grade of the septal mucosa was within one point of the ethmoid mucosa in 36 (85.7%) cases, and correlated exactly in 24 patients (57.1%). A statistically significant correlation was found between septal and ethmoid mucosa inflammation grades (p = 0.048). No significant difference in mean non-eosinophilic inflammatory cell count per HPF was noted betmeen ethmoid mucosa and septal mucosa (48.2 versus 54.3 cells/HPF, p = 0.061, power = 0.873). Ethmoid mucosa had a significantly higher mean eosinophil count than septal mucosa (6.6 versus 1.9 cells/HPF, p < 0.001). For combined inflammatoty cell counts, no significant difference in cell counts was noted (54. 7 cells/HPF ethmoid versus 56.1 septal, p = 0.670, power = 0.847). Histopathologic evidence of rhinitis is associated with chronic sinusitis. This supports the concept of rhinosinusitis rather than sinusitis alone. Eosinophils are found in significantly higher numbers in sinus mucosa than in nasal mucosa, suggesting a site-specific role in rhinosinusitis.     

Rho激酶-1在变应性鼻炎小鼠上下呼吸道表达特点及布地奈德的干预作用

目的：观察Rho激酶-1在变应性鼻炎上下呼吸道表达特点及布地奈德对其表达影响,探讨Rho激酶-1在变应性鼻炎上下呼吸道炎症反应中的作用。方法应用卵清蛋白致敏建立小鼠变应性鼻炎模型,30只小鼠随机分为：变应性鼻炎组,布地奈德组和正常对照组。所有小鼠于末次激发后24小时处死,收集鼻腔灌洗液和肺泡灌洗液查炎症细胞计数,应用免疫组化方法检测鼻黏膜和肺组织中Rho激酶-1蛋白表达。结果变应性鼻炎组鼻黏膜和肺组织内Rho激酶-1蛋白阳性表达水平显著高于正常对照组（P〈0.05）。变应性鼻炎组小鼠鼻腔灌洗液和肺泡灌洗液中以炎症细胞总数和嗜酸性粒细胞增加明显（P〈0.05）。应用布地奈德干预治疗后,小鼠鼻黏膜和肺组织内Rho激酶-1蛋白阳性表达较变应性鼻炎组水平降低,小鼠鼻腔灌洗液和肺泡灌洗液中以炎症细胞总数和嗜酸性粒细胞数较变应性鼻炎组减少。Rho激酶-1蛋白表达与炎症细胞和嗜酸性粒细胞数呈正相关（P〈0.01）。结论 Rho激酶-1蛋白参与变应性鼻炎上下呼吸道炎症反应过程,布地奈德可通过调节Rho激酶-1的表达减轻炎症反应。     

变应性鼻炎与慢性鼻窦炎的关系

目的:观察常年性变应性鼻炎患者鼻窦炎发生的原因及发生率。方法:回顾性分析57例常年性变应性鼻炎患者的临床资料。结果:18例并发鼻窦炎,发生率为32%;其中17例伴有不同程度不同类型的鼻腔解剖结构异常,包括鼻中隔偏曲、中鼻甲气化、钩突肥大、中鼻甲曲线异常和鼻丘气房过度发育等。39例单纯变应性鼻炎者只有7例伴有鼻腔解剖结构异常。结论:变应性鼻炎并发鼻窦炎的基础可能是鼻腔解剖结构异常,变态反应导致的鼻腔黏膜水肿和鼻腔分泌物性质的改变是鼻窦炎的诱发因素之一。     

A role for neutrophils in intermittent allergic rhinitis

Objective In patients with intermittent allergic rhinitis, allergen challenge may induce both early- and late-phase responses. The aim of this study was to examine the correlation between inflammatory cells in the nasal lavage fluid and clinical parameters following pollen challenge.

Material and Methods Nasal lavage fluids were obtained from 29 patients with intermittent allergic rhinitis before and 1 and 6 h after allergen provocation, representing the control, early and late phases, respectively. Symptom and rhinoscopic scores were registered on the same occasions. Inflammatory cells were determined in the nasal fluid.

Results The early phase was characterized by increased symptom scores, rhinoscopic signs of oedema and secretion and neutrophilia. In the late phase, symptom scores had diminished, but the signs of ongoing secretion remained. Both the total nasal symptom score and the secretion score correlated with the number of neutrophils in lavage fluids at 1 h. The eosinophil count did not increase during the early or late phases.

Conclusion A single allergen provocation induces an early-phase response dominated by neutrophils, with secretion being the only clinical sign remaining during the late phase. The increase in neutrophil numbers correlated with the registration of secretory symptoms. The presented data indicate a role for neutrophils in intermittent allergic rhinitis and their relation with secretory parameters makes it intriguing to speculate that neutrophils may function as promoters of nasal secretion.