Role of angiotensin-converting enzyme on bradykinin nasal provocation: comparison of normal volunteers and allergic subjects

Nasal allergy is the most common type I allergic disease. During allergic reaction, chemical mediators may be released from residual cell, and thus, attract additional inflammatory cells. One mediator implicated in this response is bradykinin (BK), a potent proinflammatory nonapeptide. This study was designed to investigate the effects of BK on nasal mucosa, and to determine the role of angiotensin-converting enzyme (ACE) in BK-induced nasal responses. BK nasal provocation (100 micrograms) was studied in 7 normal volunteers and 7 patients with perennial allergic rhinitis. After provoking of BK response, nasal secretions and saline lavage fluids were collected for analysis of total protein (a protein secretion marker), albumin (a vascular permeability marker), and lysozyme (a serous cell marker). In addition, after administering of Captopril 50 mg, a specific ACE inhibitor, the same protocol was performed. In both groups, BK induced plasma exudation and serous gland secretion. Premedication with captopril did not alter BK-induced responses in normal individuals. In allergic patients, captopril enhanced BK-induced vascular permeability, but not glandular secretion. These results indicate that allergic subjects have nasal hyperresponsiveness to BK, and that ACE predominantly modulates the vascular permeability of allergic nasal mucosa. It seems likely that BK may contribute to the expression of nasal allergic symptoms, and that inhibition of ACE may lead to increased nasal responsiveness.     

Distilled water nasal provocation in hyperreactive patients.

Nonisotonic aerosol may act as a provocation agent in the upper and lower airways of hyperreactive individuals. The purpose of the study was to compare the results of nasal challenge with distilled water in patients with allergic rhinitis to those with noninfective nonallergic rhinitis (NINAR), with respect to the potential clinical use of the obtained data. A group of 68 ambulatory patients with allergic rhinitis or NINAR (39 perennial allergic, 6 seasonal, 23 NINAR) were challenged with 10 mL of distilled water aerosol after the baseline active anterior rhinomanometry. Patients with nasal polyposis at endoscopy, significant unilateral septal deviation, positive bacteriologic swab, recent nasal surgery, and uncertain anamnestic data about the medication taken 6 weeks before the provocation were excluded from the study. After 10 minutes of nasal provocation, rhinomanometry was repeated to assess the response. In 15 patients of the perennial allergic group, the same measurements were performed after a 2-week oral antihistamine and topical steroid therapy. Nasal resistance was significantly increased on the more patent side of the nose after nasal provocation with distilled water aerosol in allergic patients in comparison to the nasal resistance before provocation. In the patients with NINAR, the provocation resulted in a significant rise on the more patent side, but the total nasal airway resistance (NAR) levels were also significantly increased. The systemic antihistamine and topical steroid 2-week therapy in patients with perennial allergic rhinitis significantly reduced the response to nasal distilled water provocation. Nasal provocation with distilled water aerosol is a cheap, simple, and acceptable method that provides useful clinical data on the level of nonspecific nasal hyperreactivity and the therapy success.     

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.     

VEGF在伴鼻息肉的慢性鼻-鼻窦炎中的表达及克拉霉素对其的调节作用

目的：探讨血管内皮生长因子（VEGF）在伴鼻息肉的慢性鼻-鼻窦炎（CRSwNP）患者鼻黏膜中的表达及克拉霉素对其的调控作用。方法：收集16例CRSwNP组织及21例单纯鼻中隔偏曲患者下鼻甲黏膜,采用实时定量RT-PCR方法检测样本中VEGF的表达。另外收集10例伴鼻息肉的慢性鼻窦炎鼻息肉组织及5例单纯鼻中隔偏曲患者下鼻甲黏膜,采用体外组织块培养及ELISA方法,观察克拉霉素对VEGF表达的调节作用。结果：①VEGF mRNA在CRSwNP组的表达较对照组增高,差异有统计学意义（P〈0.01）;②经克拉霉素刺激前后比较,CRSwNP组织中VEGF蛋白的表达量下降,差异有统计学意义（P〈0.05）。结论：CRSwNP组织中VEGF的表达显著升高,推测VEGF在鼻息肉的发病机制中具有极其重要的作用。克拉霉素可能通过抑制VEGF的表达而达到治疗慢性鼻-鼻窦炎的作用。     

The effect of allergen provocation on the nasal cycle estimated by acoustic rhinometry

CONCLUSION: The overall duration and reciprocity of the nasal cycle were not changed after allergen provocation. The duration of immediate response was 38 min, but the amplitude of the nasal cycle was increased significantly after allergen provocation. OBJECTIVE: Nasal airflow is asymmetrical and subjected to spontaneous reciprocal changes which are referred to as the nasal cycle. Limited information is available on how this is affected by allergens. The purpose of this study was to evaluate the effects of allergen provocation on the nasal cycle. MATERIALS AND METHODS: This study was performed on 25 patients with allergic rhinitis and 25 subjects in a control group with no symptoms of allergic rhinitis. Acoustic rhinometry was used to test patients before and after allergen provocation. The patients underwent acoustic rhinometry at 15-min intervals for evaluation of nasal cycle and 3-min intervals for immediate response. RESULTS: With the allergic patients, 21 of the 25 patients (84.0%) showed a nasal cycle and they still had a nasal cycle after the allergen provocation. In the study on the changes in the immediate responses, the average recovery time was 38 min and the reduction rate of the non-patent side was higher than that of the patent side. Also, the average period of the nasal cycle was 153 min before the allergen provocation and 140 min on average after the allergen provocation; there were no statistical differences. The amplitude of each nasal cycle increased after allergen provocation and the difference had statistical meaning.     

Nasal passage patency in patients with allergic rhinitis measured by acoustic rhinometry: nasal responses after allergen and histamine provocation

We investigated nasal passage patency after allergen and histamine provocation in patients with allergic rhinitis by acoustic rhinometry. In total, 75 outpatients with allergic rhinitis were studied. The threshold of nasal hypersensitivity to histamine was measured by the 10 μl instillation of serial 10-fold dilution in the ipsilateral nasal cavity. Nasal provocation testing to specific antigen was applied to the anterior part of inferior turbinate in bilateral sides in sitting position. Measurement of nasal patency by acoustic rhinometry was repeated three times in each nasal cavity. The minimal cross-sectional area and total volume of nasal cavity were measured in an individual subject. The minimal cross-sectional area and total volume in the histamine challenged-side significantly decreased on the 10⁻², 10⁻¹, 10⁻⁰ of end point, and up to 30 min after challenge with the threshold dose, but not in the unchallenged side. This means acoustic reflection technique is sensitive at least 100-fold in comparison with classical method like findings by anterior rhinoscopy and symptom scores. Nasal passage patency after bilateral allergen provocation showed predominant in the unilateral side, suggesting the cross over-reflex effects.It was concluded that acoustic rhinometry is one of the highly quantitative and sensitive method which can observe the change of nasal congestion.     

Endothelin-1 and bradykinin in nasal lavage fluid of patients allergic to tree pollen

Hay fever is one of the most frequent upper airway diseases. The nasal epithelium is considered to play and active role in the allergic inflammation through its capacity to synthesize and release a wide range of cytokines and mediators. One substance of potential relevance in this regard is endothelin (ET). We postulated that ET-1 could contribute to pathomechanism of seasonal allergic rhinitis. The aim of this study was to demonstrate release of this peptide and bradykinin into the nasal lavage fluid (NLF) of tree pollen allergic patients in response to allergen challenge. 16 subjects aged 25.5 +/- 3.3 years with clinical history of tree pollen allergic rhinitis participated in the study. Nasal allergen provocation with following lavage was performed in all subjects. Ten of them were hyposensitized preseasonally by allergic vaccine Allergovit (Allergopharma, Germany). Six patients received treatment with antihistamines, cromoglicates or steroids. Bradykinin and endothelin-1 in the nasal secretion were assayed before starting immunotherapy and early during tree pollen season. Increase in concentration of bradykinin in nasal lavage fluid from hyposensitized patients were significantly lower than from second group, 509.4 +/- 110.4 before 942.9 +/- 234.89 pg/ml after allergen provocation versus 417.8 +/- 100.4 and 2001.6 +/- 223.6 pg/ml (p < 0.05). We noticed lower concentration of ET-1 in NLF of hay fever patients, 17.5 +/- 3.9 versus 13.9 +/- 2.7 pmol/ml. We conclude that bradykinin and endothelin-1 could be involved in the pathogenesis of hay fever.     

Evaluation of immunotherapy by nasal antigen challenge.

BACKGROUND: Nasal antigen challenge test is used to evaluate the allergic conditions within different diagnostic procedures. OBJECTIVE: This study was conducted to evaluate the efficacy of immunotherapy (IT) in an objective and simple way in children with perennial allergic rhinitis. METHOD: This study was a double-blind, placebo-controlled procedure. Nineteen patients (mean age 10 +/- 6 years) were treated only with IT and 17 patients (mean age 11 +/- 5 years) constituted the control group without any treatment. The patients were evaluated at the beginning and at 3 and 6 months of IT. Nasal provocation reactions were evaluated and scored at 5-, 10-, and 30-minute intervals. RESULTS: In the IT group, mean clinical scores and mean nasal provocation scores decreased significantly between the initial value and at 3 and 6 months of IT, whereas there was no significant change in the value for the control group. There were no significant differences among the 5-, 10-, 15-, and 30-minute evaluations within both the IT and control groups. CONCLUSION: The efficacy of IT in perennial allergic rhinitis may be assessed by the nasal antigen challenge test in a simple and objective way within a 5-minute period.     

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.     

Endothelin-1 in nasal lavage fluid of allergic rhinitis patients--new mediator of allergic rhinitis

The nasal epithelium is considered to play an active role in the allergic inflammation through its capacity to synthesize and release a wide range of cytokines and mediators. Few studies have investigated the involvement of endothelin-1 in the pathogenesis of inflammatory diseases of the upper airways. To examine the release of endothelin-1 from nasal mucosa after allergen challenge we investigated 24 patients. 15 subjects (7 male, 8 female) allergic to birch pollen aged 37.1 +/- 4.9 years participated in the study. Nasal birch allergen provocation with following lavage was performed in all subjects. Endothelin-1 in the nasal secretion were assayed before and after challenge. Increase in concentration of endothelin-1 in nasal lavage fluid from allergic patients were significantly higher than in control group respectively from 18.33 +/- 5.47 fmol/ml to 26.41 +/- 6.92 fmol/ml versus 18.8 +/- 3.99 to 19.80 +/- 4.18 fmol/ml (p < 0.05) in controls. We conclude that endothelin-1 could be involved in the pathogenesis of seasonal allergic rhinitis.     

The relationship between allergy and rhinosinusitis

BACKGROUND: IgE-mediated hypersensitivity is considered by some to be a predisposing factor for developing rhinosinusitis, although the theory is still controversial. The purpose of this study was to evaluate the relationship between allergy and rhinosinusitis. DESIGN: A cross-sectional study. METHODS: 198 rhinitis patients were enrolled. An allergy skin prick test was done and the subjects categorized as allergic or nonallergic. Nasal endoscopy and sinus radiography were performed. The criteria for diagnosis of rhinosinusitis were rhinitis symptoms and positive nasal endoscopy (discharge from middle and/or superior meatus) and/or abnormal sinus radiography. RESULTS: Allergic patients were significantly more likely to have abnormal findings on sinus radiography than non-allergic patients (p < 0.001) and would therefore fulfill the criteria on which rhinosinusitis may be diagnosed, but the two groups were not significantly different in positive nasal endoscopy results (p = 0.553). Among the patients with abnormal sinus radiography, the allergic patients were significantly less likely to have a positive nasal endoscopy compared to the nonallergic patients (p = 0.006). CONCLUSIONS: Allergic rhinitis subjects were significantly more likely to have abnormal findings on sinus radiography compared with nonallergic subjects potentially leading to a diagnosis of rhinosinusitis. However, they were also significantly more likely to have abnormal sinus radiography with negative nasal endoscopy than the nonallergic subject. These findings could suggest an association between allergic rhinitis and rhinosinusitis via IgE mediated hypersensitivity.     

Nasal provocation tests with house dust mite in patients with perennial rhinitis

The aim of this study was to evaluate a response of the upper airways mucosae to allergens house dust mite: Dermatophagoides farinae and Dermatophagoides pteronyssinus. Compared were results of nasal challenge with results of skin prick tests. 87 patients with perennial rhinitis allergic to Dermatophagoides farinae and/or Dermatophagoides pteronyssinus were included. There were 58 men, 29 women, age 18-54 years, mean age 26 years. Nasal provocation tests were performed first with solvent, and next if flow rate did not change more than 20%, with Dermatophagoides farinae and Dermatophagoides pteronyssinus extracts. The nasal response was evaluated with active anterior rhinomanometry. Nasal flow was measured at 15, 30 and 45 minutes after allergen challenge. There were 99% positive skin prick tests Dermatophagoides farinae and 94% positive skin prick tests Dermatopagoides pteronyssinus. Nasal provocation tests with Dermatophagoides farinae extract were positive in 63% patients and Dermatophagoides pteronyssinus extract--in 62% patients. Majority of nasal challenges were positive at 15th minute. There is association between skin prick tests Dermatophagoides farinae and Dermatophagoide pteronyssinus 4+ and positive nasal provocation tests with the same allergen (p < 0.05). We have found correlation between skin tests Dermatophagoides farinae and Dermatophagoides pteronyssinus (correlation index = 0.58) and no correlation between nasal provocation Dermatophgoides farinae and Dermatophagoides pteronyssinus extracts. CONCLUSION: Nasal provocation tests are more specific than skin prick tests in patients with perennial rhinitis.     

The study of chemical mediators in the patients with allergic rhinitis 2). Histamine, leukotriene and kinins in the nasal secretion during dual phase response

In order to clarify the details of a late phase response (LPR) in allergic rhinitis, serial changes of nasal symptoms and concentration of chemical mediators (histamine, leukotriene (LT) C4 and kinins) in nasal lavage fluid were investigated after the nasal antigen challenge in ten patients with perennial allergic rhinitis with a positive intradermal skin reaction to mite extract. Samples were collected periodically for 8 hours following the challenge. Nasal airway resistance (NAR) and clinical symptoms were also recorded serially. Three out of ten patients showed only early phase response (EPR) and the other seven patients showed both early and late phase response after the challenge. The chief nasal symptom in LPR was nasal obstruction. In EPR, concentrations of chemical mediators in the nasal lavage fluid always increased. In dual (early and late) phase responders, increases of chemical mediators in nasal lavage fluids were notable during both early and late phase responses. In EPR, there was a significant correlation between severity of sneezing attack and concentration of histamine. In LPR, increase of LTC4 level was significantly correlated with the increase of NAR. RAST score and daily nasal symptoms tended to be higher and more sever in dual phase responders compared with early phase responders. We suggest that the amounts of released chemical mediators during allergic reaction denoted the LPR in allergic rhinitis patients.     

Cholinergic blockade does not alter the nasal congestive response to irritant provocation

OBJECTIVE: To understand the mechanism underlying the nasal congestive response to irritant challenge. METHODS: We exposed 22 subjects--8 with seasonal allergic rhinitis (SAR), 6 with perennial allergic rhinitis (PAR), and 8 normals--to chlorine (Cl2) gas (1.0 ppm x 15 min.) by nasal CPAP mask. Control exposures (filtered air) were carried out on separate days, with counter-balancing of exposure order. Nasal airway resistance (NAR) was measured in triplicate before and after the provocation sequence using active posterior rhinomanometry. For each subject, this experiment was repeated twice, after [double-blinded] pre-treatment with: 1) ipratropium bromide (IB) 0.6% nasal spray, and 2) vehicle. RESULTS: As a group, allergic rhinitics (SAR + PAR) showed greater [Cl2] exposure-related increases in NAR than did normals on placebo (vehicle) pretreatment days (p < 0.05). IB pre-treatment, however, did not have a systematic effect on Cl2-induced congestion. CONCLUSION: Cholinergic mechanisms do not appear to be responsible for the nasal congestive response to irritant provocation.     

The effect of levocabastine and furosemide pretreatment on hyperreactive response after nasal provocation with hypotonic aerosol in subjects with allergic rhinitis

Patients with allergic rhinitis demonstrate hyperreactive response in distilled water nasal provocation, shown by significant increase in nasal airway resistance (NAR). Antihistamines, including topical antihistamine, levocabastine, reduce response in non-specific nasal provocation tests. Furosemide is a diuretic which reduces hyperreactivity in lower airways, but the mode of its action is not yet fully understood. In this study, we hypothesized that either levocabastine or furosemide pre-treatment in allergic rhinitis patients reduced response to nasal challenge with non-isotonic aerosol. To test the hypothesis, we measured the effect of pre-treatment with levocabastine and furosemide in topical application on suppression of hyperreactive response to distilled water nasal inhalation. Nasal resistance was measured, prior to and after the provocation, by active anterior rhinomanometry in two randomized groups of patients, according to pre-treatment, either by levocabastine or furosemide, 20 patients in each group, respectively. Nasal airflow resistance and level of hyperreactive response considering nasal eosinophilia were tested. Significant increase in nasal resistance following provocation was found at baseline conditions (without pre-medication); pre-treatment with levocabastine and furosemide has suppressed such response. Patients with positive nasal eosinophilia showed a significantly higher increase in nasal resistance compared to those with negative smears. Furosemide has shown significantly better protective effect on nasal resistance increase in patients with positive eosinophils nasal smears. Levocabastine and furosemide pre-treatment suppress hyperreactive response to distilled water nasal provocation. Comparison of resistances (pre-treatment vs. without) showed more protective effect of furosemide, measured on both better and worse patent side of nose, in contrast to levocabastine group for which it was shown only on better patent side prior to provocation. Protection of furosemide was significantly more pronounced in patients with significant nasal eosinophilia.     

Clinical study and literature review of nasal irrigation

OBJECTIVES/HYPOTHESIS: Nasal disease, including chronic rhinosinusitis and allergic rhinitis, is a significant source of morbidity. Nasal irrigation has been used as an adjunctive treatment of sinonasal disease. However, despite an abundance of anecdotal reports, there has been little statistical evidence to support its efficacy. The objective of this study was to determine the efficacy of the use of pulsatile hypertonic saline nasal irrigation in the treatment of sinonasal disease. Study DESIGN: A prospective controlled clinical study. METHODS: Two hundred eleven patients from the University of California, San Diego (San Diego, CA) Nasal Dysfunction Clinic with sinonasal disease (including allergic rhinitis, aging rhinitis, atrophic rhinitis, and postnasal drip) and 20 disease-free control subjects were enrolled. Patients irrigated their nasal cavities using hypertonic saline delivered by a Water Pik device using a commercially available nasal adapter twice daily for 3 to 6 weeks. Patients rated nasal disease-specific symptoms and completed a self-administered quality of well-being questionnaire before intervention and at follow-up. RESULTS: Patients who used nasal irrigation for the treatment of sinonasal disease experienced statistically significant improvements in 23 of the 30 nasal symptoms queried. Improvement was also measured in the global assessment of health status using the Quality of Well-Being scale. CONCLUSIONS: Nasal irrigation is effective in improving symptoms and the health status of patients with sinonasal disease.     

Clinical symptoms and mediators in the allergic early and late phase reaction

BACKGROUND: This examination focused on the allergic early and late phase reaction via nasal symptom scores, acoustic rhinometry, and the determination of mediators possibly involved in late phase eosinophilia. We examined nasal secretions for IL-5; the chemokines IL-8, MCP-1, and Eotaxin; the adhesion molecule sVCAM-1, and the leukotriene LTC4 for their suggested impacts on tissue eosinophilia. METHODS: 13 patients suffering from seasonal allergic rhinitis were challenged intranasally out of the natural pollen season by their specific allergen. In a time window of 8 h following the provocation, patients completed symptom questionnaires, and underwent acoustic rhinometry. Nasal secretions were gained by the cotton wool method over a time period of 8 h. Nasal secretions were analyzed for the above mentioned mediators. RESULTS: Individual evaluation of the acoustic rhinometry measurements revealed an early phase reaction in 100 % of the cases and a late phase reaction in 92 %. The need to sneeze and a runny nose were the strongest symptoms during the allergic early and late phase reaction. A typical late phase kinetic was observed for IL-5, MCP-1, Eotaxin, sVCAM-1, and LTC4. IL-8 was characteristic for early phase reaction but increased in late phase as well. CONCLUSIONS: The need to sneeze, a runny nose, and the overall quality of life were most apt to evaluate the allergic early and late phase reaction. Highly significant correlations between nasal obstruction and acoustic rhinometry measurements indicate a high sensitivity of visual analogue scales in the representation of minimal changes in nasal symptom scores during the allergic reaction. Our data point to a relevant role of the TH2 cytokine IL-5; of the chemokines IL-8, MCP-1, and Eotaxin; of the adhesion molecule sVCAM-1, and of the leukotriene LTC4 for the allergic late phase eosinophilia.     

Humoral mucosal immunity in allergic rhinitis

BACKGROUND: Mucosa-immunologic aspects are gaining an increasing awareness in the pathophysiology of type I allergies. Humoral mucosal immune responses are dominated by secretory IgA, but there is evidence for a relevant role of IgG in nasal mucosa-associated lymphoid tissue. OBJECTIVE: was to measure allergen-specific immunoglobulins (IgA and IgG) in nasal secretions as an expression of a humoral mucosal immune response in allergic rhinitis. For tissue eosinophilia we studied nasal Eosinophilic Cationic Protein (ECP) and for mast cell activation nasal tryptase. METHODS: Nasal secretions of 40 patients suffering from allergic rhinitis were analyzed for allergen-specific IgA, IgG, and IgE, and for ECP and tryptase. Patients were highly sensitized against the major allergens of house dust mites, timothy, and birch pollen. 43 non-atopic individuals served as controls. In order to study possible effects of the actual pollen season on the studied parameter we secondly compared patients allergic to seasonal allergens co- (n = 28) and extra-seasonally (n = 41). In order to determine a possible influence of allergen-specific IgA in eosinophilic degranulation we additionally studied 5 patients after nasal allergen challenge. RESULTS: In allergic rhinitis we found significantly increased levels of allergen-specific immunoglobulins of all studied subclasses and allergens in nasal secretions. Comparison of nasal ECP and tryptase showed significantly increased concentrations in allergic individuals as well. Co-seasonally we found elevated allergen-specific IgE, ECP, and tryptase but lower concentrations of allergen-specific IgA and IgG. There was no association between late phase eosinophilia and IgA concentrations after local allergen challenge. CONCLUSIONS: The occurrence of allergen-specific immunoglobulins in nasal secretions is interpreted as a local humoral mucosal immune response. The physiologic role of local allergen-specific immunoglobulins is not clear to date. Involvement in degranulation of eosinophils or mast cells, like suggested before, seems unlikely.     

Immunoglobulins in nasal secretions of patients with allergic rhinitis and chronic rhinosinusitis

Allergic rhinitis and chronic rhinosinusitis are the most frequently encountered inflammatory reactions of the sinonasal mucosa. Nasal-associated lymphoid tissue has been suggested as an inductive site for humoral and cellular immune responses in the upper respiratory tract. Immunoglobulins are important elements in human adaptive immune responses and deficiencies of serum immunoglobulins may be associated with recurrent or refractory infections. However, the local humoral immune response to offending antigens in the nasal environment has not been well elucidated. To determine the levels of IgA and IgG subclasses antibodies in the nasal secretions of patients with allergic rhinitis and chronic rhinosinusitis, 25 patients with allergic rhinitis and 20 with chronic rhinosinusitis were included and their nasal secretions were collected to measure the levels of secretary IgA (sIgA), total IgA (tIgA), and IgG subclasses antibodies. There was a significant elevation of IgG₃ in the nasal secretions of patients with chronic rhinosinusitis. No difference was noted in the levels of sIgA, tIgA, IgG₁, IgG₂ and IgG₄ among the three groups. The local defense mechanism of nose reacts to microorganisms and pathogenic antigens by inducing the adaptive humoral immune response to increase the amount of immunoglobulins, with IgG₃ being the major up-regulated antibody.     

The effect of allergen provocation on the nasal cycle estimated by acoustic rhinometry

Conclusion. The overall duration and reciprocity of the nasal cycle were not changed after allergen provocation. The duration of immediate response was 38 min, but the amplitude of the nasal cycle was increased significantly after allergen provocation.

Objective. Nasal airflow is asymmetrical and subjected to spontaneous reciprocal changes which are referred to as the nasal cycle. Limited information is available on how this is affected by allergens. The purpose of this study was to evaluate the effects of allergen provocation on the nasal cycle.

Materials and methods. This study was performed on 25 patients with allergic rhinitis and 25 subjects in a control group with no symptoms of allergic rhinitis. Acoustic rhinometry was used to test patients before and after allergen provocation. The patients underwent acoustic rhinometry at 15-min intervals for evaluation of nasal cycle and 3-min intervals for immediate response.

Results. With the allergic patients, 21 of the 25 patients (84.0%) showed a nasal cycle and they still had a nasal cycle after the allergen provocation. In the study on the changes in the immediate responses, the average recovery time was 38 min and the reduction rate of the non-patent side was higher than that of the patent side. Also, the average period of the nasal cycle was 153 min before the allergen provocation and 140 min on average after the allergen provocation; there were no statistical differences. The amplitude of each nasal cycle increased after allergen provocation and the difference had statistical meaning.