Ciliary activity in patients with nasal allergies

Summary The ampullary wall of the posterior semicircular canal was isolated from the frog, cut and the cupula exposed in frog Ringer's solution. The cupula was stimulated by depression with a fine glass micropipette. Three points on the cupula were selected for depression: point A, the lowest point on the midline of the cupula surface on the utricular side; point B, the uppermost on the midline of the same surface; and point C, in the middle of the lateral surface of the cupula. Depression at points A and B was toward the canal, whereas depression at point C was toward the centre of the cupula. The amount of depression was controlled by a micromanipulator. At point A, the minimum depression facilitating the posterior canal action potential was 1 ; at point B, a greater amount of depression was needed to produce the action potential. Even a large amount of depression at point C resulted in only a small action potential, possibly because the direction of the sensory cell polarity is along the long axis of the canal.     

Enhancement of submicroscopic damage of the nasal epithelium by topical allergen challenge in patients with perennial nasal allergy

The purposes of this study were to clarify whether damage of the nasal epithelium exists in patients with nasal allergy, and how the morphology of the epithelium changes after topical allergen challenge. Electron microscopy revealed 2 characteristic features in the nasal epithelium of patients with perennial nasal allergy--an increase in the number of epithelial cells with cytoplasmic vacuoles, and markedly widened intercellular spaces--although these changes were unclear under light microscopy. The density of vacuolated cells significantly increased 24 hours after allergen challenge. Further, the number of eosinophils that were associated with vacuolated cells was significantly higher in patients with nasal allergy than in controls. These morphological changes, thus, were considered to be types of damage to the nasal epithelium associated with nasal allergy. Such changes may be among the causes of nasal hyperreactivity, which is an important feature of nasal allergy.     

Study of eosinophil activation in nasal mucosa in patients with perennial nasal allergy: effects of CO2 laser surgery

Carbon dioxide (CO2) laser surgery has been shown to be clinically effective in the treatment of nasal allergy. To investigate the mechanisms of eosinophil infiltration and activation underlying the therapeutic effects of CO2 laser surgery, we examined changes in the cytological profile of nasal mucosa after surgery. Twenty-two patients with perennial nasal allergy against house-dust mites underwent two or three rounds of laser surgery at 1-month intervals on an outpatient basis. The following parameters were evaluated at each visit: (i) improvement of clinical symptoms (nasal obstruction, rhinorrhea, and sneezing), (ii) percentage of infiltrating eosinophils in nasal mucosa, and (iii) the degree of EG2+ cells and intracellular adhesion molecule 1 (ICAM-1) expression by immunocytochemistry. All clinical symptoms significantly decreased after surgery. Significant reductions in eosinophil infiltration (p < 0.01) and the percentage of EG2+ cells (p < .005) were observed also. However, the degree of ICAM-1 expression in epithelial cells was not changed. These results suggest that CO2 laser surgery partially reduced the allergic reactions, leading to improvement of clinical symptoms.     

Respiratory function in patients with perennial nasal allergy and pollinosis]

There are many patients with allergic rhinitis who have no lower airway symptoms. The question arises as to whether or not the lower airway is involved in such cases, but the results of investigations in this field remain controversial. To answer this question, I performed various respiratory function tests in patients with perennial nasal allergy or pollinosis with or without a history of bronchial asthma. In addition, physiological changes in lower airway lesions were evaluated after challenge with antigen and histamine in these patients. In the present study, respiratory function was examined by autospirometry and the following results were obtained. 1. The group with perennial nasal allergy and a history of bronchial asthma showed significantly lower FEV1.0%, PER, %VC, V75, V50, and V25 values than the group with perennial nasal allergy without history of bronchial asthma, indicating an obstructive lesion in the lower airway. The group with perennial nasal allergy alone showed lower V75, V50, and V25 values than the control group, suggesting small airway obstruction. 2. The group with perennial nasal allergy and a history of bronchial asthma showed marked hypersensitivity in the lower airway after histamine inhalation. The group with perennial nasal allergy alone showed marked changes in V75, V50, and V25: the degree was between that of the control group and that in the group with a history of asthma. 3. In patients with pollinosis, various respiratory function tests showed no abnormalities during the in-season of pollinosis and the out-seasons. However, inhalation of antigen or histamine decreased various parameters, significantly V50 and V25, during the symptomatic season.(ABSTRACT TRUNCATED AT 250 WORDS)     

Role of IL-31 in regulation of Th2 cytokine levels in patients with nasal polyps

Interleukin-31 (IL-31) is reported to be involved in Th2 cell-mediated diseases. However, the regulatory effect of IL-31 in the pathogenesis of nasal polyps (NPs) has not been understood. This study is aimed to determine whether IL-31 production is associated with Th2 cytokine levels and clinical severity in patients with NPs. Thirty patients with NPs and fifteen normal controls were included, and IL-31 production was determined by immunohistochemistry and enzyme-linked immunosorbent assay, respectively. The relationship between IL-31 expression and clinical severity was also evaluated. Besides, the effect of IL-31 on Th2 cytokine expression by polyp epithelial cells was investigated. We observed significantly enhanced IL-31 mRNA and protein level expression in NPs compared with normal control. IL-31+ cells were found to be positively correlated with clinical severity of NPs. Furthermore, we provided the direct evidence that IL-31 up-regulates Th2 cytokines expressed by polyp epithelial cells. Our results demonstrate that enhanced Th2 cytokine levels was correlated with IL-31 expression in NPs and provide a possible explanation for IL-31’s regulatory role in the pathogenesis of NPs.     

Argon plasma surgery for the inferior turbinate of patients with perennial nasal allergy

OBJECTIVES: Argon plasma coagulation (APC) is a new electrosurgical modality. The advantages of APC are coagulating of the target tissue without contact and the creation of uniformly deep devitalized and coagulated zones. The objectives of the present study were to determine the clinical effects of APC for the inferior turbinate of patients with nasal allergy and to clarify the histological changes in the mucosa after APC. STUDY DESIGN: In a prospective study, 95 patients with perennial nasal allergy were treated with APC. Nasal symptoms and intranasal findings were evaluated preoperatively and 1, 3, and 6 months, and 1 year after the APC. Mucosal specimens from the turbinates were examined under light and electron microscopy. RESULTS: Nasal stuffiness was improved in 77 of 79 (97.5%) patients after 1 month, in 50 of 51 (98.0%) patients after 3 months, in 20 of 23 (87.0%) patients after 6 months, and in 9 of 12 (75.0%) patients at 1 year after the APC. Rhinorrhea was improved in 46 of 75 (61.3%) patients after 1 month, in 40 of 51 (78.4%) patients after 3 months, in 16 of 21 (76.2%) patients after 6 months, and in 6 of 10 (60.0%) patients at 1 year after the APC. The sneezing was improved in 32 of 54 (59.3%) patients after 1 month, in 21 of 35 (60.0%) patients after 3 months, in 10 of 14 (71.4%) patients after 6 months, and in 6 of 8 (75.0%) patients at 1 year after the APC. In the intranasal findings, congestion of the inferior turbinate improved in 75 of 76 (98.7%) patients after 1 month, in 49 of 52 (94.2%) patients after 3 months, in 20 of 23 (87.0%) patients after 6 months, and in 7 of 11 (63.6%) patients at 1 year after the APC. The nasal discharge was reduced in 40 of 75 (53.3%) patients after 1 month, in 32 of 52 (61.5%) patients after 3 months, in 15 of 22 (68.2%) patients after 6 months, and in 5 of 11 (45.5%) patients at 1 year after the APC. No patients needed nasal packing after the APC. CONCLUSIONS: This is the first report on the clinical effects of turbinate surgery for nasal allergy using APC. APC was useful fer turbinate surgery of nasal allergy, especially for nasal stuffiness and congestion of the turbinate.     

复发性鼻息肉病人外周血Th1、Th2细胞的流式细胞分析

目的探讨T淋巴细胞活化及释放的Th1、Th2细胞因子失平衡与鼻息肉发病的关系。方法用流式细胞仪测定30例鼻息肉病人和30例健康人的外周血单个核细胞(PBMC),经PMA诱导培养后测定Th1细胞内IFN-γ和Th2细胞内IL-4的水平。结果鼻息肉组的Th2细胞(CD3 CD8-IL-4 )和Th1细胞(CD3 CD8-IFN-γ )水平显著高于正常组(P<0.05)。结论鼻息肉病人体内激活的Th细胞中,Th1细胞和Th2细胞均增高,并分泌多种细胞因子,在鼻息肉的发生发展中起到调节作用。     

Short-term effect of argon plasma coagulation of the inferior turbinate in patients with perennial nasal allergy

The aim of this study was to clarify the short-term effects of argon plasma coagulation (APC) of the inferior turbinate in patients with perennial nasal allergy. In a retrospective study, 32 patients with perennial allergic rhinitis were treated by inferior turbinate reduction using APC. Grades of nasal stuffiness, rhinorrhea, sneezing, nasal airflow resistance (NAR) and overall seriousness were evaluated before and then 1-4 and 8 weeks after APC. Subjective symptoms were assessed using a questionnaire in which nasal stuffiness, rhinorrhea and sneezing were graded on a four-point scale (severe, moderate, mild and none) using the Severity Criteria of Symptoms of Nasal Allergy issued by the Japanese Society of Allergology. NAR was measured using active anterior rhinomanometry (AAR) at the 100 Pa point; this was deemed to be an objective measurement of nasal obstruction. The numbers of patients examined before and 1-4 and 8 weeks after APC were 32, 31, 25, 17, 18 and 14, respectively. Both nasal stuffiness and NAR were significantly improved 2 weeks after APC, overall seriousness was significantly improved after 3 weeks and rhinorrhea was improved after 4 weeks. Sneezing did not significantly improve during this study. There was no significant change in the grades of the examined parameters during the period between 4 and 8 weeks after APC. The beneficial effects of APC begin to appear within 2 weeks after APC and no further improvement after about 4 weeks.     

Acoustic rhinometric assessment of nasal obstruction after treatment with fluticasone propionate in patients with perennial rhinitis

Objective: To investigate the effect of fluticasone propionate (FP) on the symptom of nasal obstruction and to assess the correlation between the subjective visual analogue score (VAS) and the objective acoustic rhinometry (AR) measurements. Methods: A prospective study of 45 consecutive patients, 30 males and 15 females with a mean age of 27 years (range: 16–59 years), with moderate/severe symptoms of perennial rhinitis who were treated by FP nasal spray for 4 weeks. AR and VAS were used to evaluate, compare and correlate the efficacy of FP nasal sprays. Results: There was a significant improvement in the VAS post-treatment (3.9) compared with pre-treatment (6.3). There was also a significant increase in the nasal volume (V) and minimum cross-sectional area (MCA) after intranasal FP. Good correlation between the total MCA and total V was noted. Subjective improvements in symptoms did not correlate well with objective measurements as the correlation between VAS and AR was poor. Conclusion: Our study provides subjective and objective evidence on the efficacy of intranasal FP in improving nasal obstruction in perennial rhinitis. AR also proved to be a useful instrument in monitoring the effectiveness of medical therapy for perennial rhinitis.     

粉尘螨点刺试验与粉尘螨鼻黏膜激发实验相关性分析

目的评价目前粉尘螨过敏的常年性变应性鼻炎（AR）患者皮肤点刺试验（skin prick test,SPT）和鼻黏膜激发实验（nasal provocation test,NPT）的相关性。方法选择90例临床症状及体征符合常年性AR的患者行SPT及NPT。结果粉尘螨SPT及NPT灵敏度分别为84.6%和100%,其SPT及NPT的特异度分别为94.1%和98.0%。阳性级别在（＋＋）、（＋＋＋）和（＋＋＋＋）的SPT阳性患者,NPT阳性率分别为24.2%、30.3%和45.5%。结论 SPT为诊断AR的必要先行检查手段,NPT对于可疑变应原的确诊、鼻黏膜的非特异性高反应性的诊断及特异性免疫治疗（specific immunotherapy,SIT）具有较高价值。SPT级别强度越高,NPT阳性率越高,但SPT级别强度与NPT液浓度之间无明显相关性。     

鼻息肉组织中Th_1、Th_2细胞因子的表达及其意义

目的 :探讨 IL- 4、IL- 5等 8种细胞因子在鼻息肉发病中的作用和对鼻息肉治疗的意义。方法 :采用酶联免疫吸附实验 (EL ISA)法检测 2 5例鼻息肉患者鼻息肉组织中 Th1 细胞因子 IFN- γ、IL- 2、IL- 12和 Th2 细胞因子 IL- 4、IL- 5、IL- 8、IL- 10、IL- 13的表达 ,并比较经皮质激素治疗前后鼻息肉中细胞因子表达的差异。结果 :2 5例中 ,IL- 4、IL- 5、IL- 8、IL- 10、IL- 13等 Th2 细胞因子的表达较正常组织增高 ,其中以 IL- 4、IL- 5最为显著 ,分别达3.9倍和 8.8倍 ;应用皮质激素后细胞因子的表达水平显著降低 ,而 IFN- γ、IL- 2、IL- 12等 Th1 细胞因子浓度较正常组织中降低 ,应用激素后其表达无明显改变。结论 :Th2 细胞因子 IL- 4、IL- 5、IL- 8、IL- 10、IL- 13等的升高 ,在鼻息肉的发病过程中可能具有重要的意义 ,通过改变 Th2 细胞因子的表达趋势 ,可能对鼻息肉的治疗具有一定的意义。     

Investigation of the nasal mucosa in perennial allergic rhinitis with SEM and TEM

The ultrastructure of 20 PAR nasal mucosa specimens was investigated with both transmission and scanning electron microscopes. The cilia were found to be defective or desquamated in advanced cases. Cilia in PAR may be divided into three types: normal, adherent and exfoliative types. It had been found that changes in cilia morphology and its function varied with the duration of the disease. The nasal mucosa showed inflammatory cell infiltration and increase in number of glands. Plasma cells full of secretory granules were found both in the epithelial layer and lamina propria. Capillaries, arterioles and venules showed various degrees of pathological changes. The cholinergic nerve endings had increased in number at the expense of the adrenergic nerve endings.     

Late phase responses after nasal challenges with allergen and histamine in asthmatic children with perennial nasal allergy

Objective: Late phase response (LPR) is difficult to investigate in patients with perennial nasal allergy because of their continuous presentation with nasal symptoms. Contribution of histamine to the LPR is also controversial. In this study, we investigated whether exogenous histamine can induce LPR in asthmatic patients with perennial nasal allergy to house dust. Methods: A total of 40 asthmatic children were divided into clinical, subclinical and non-rhinitis groups based on their daily nasal symptoms. Changes in nasal patency and in inflammatory cells in nasal secretion were quantitatively measured for 6 h by acoustic rhinometry and light microscopy respectively before and after nasal challenge with allergen or histamine. Results: The allergen challenge produced a significant biphasic decrease in nasal patency in the subclinical group and a marginal decrease in the clinical group, with increases in eosinophils 6 h after the challenge. By contrast, histamine challenge induced significant responses in the clinical group and only a slight response in the subclinical group. Eosinophils also accumulated in nasal secretion of the clinical group to significant levels 6 h after histamine challenge. Eosinophil accumulation following histamine challenge was earlier than that after exposure to allergen. Conclusion: We conclude that LPR can be demonstrated in asthmatic children with perennial nasal allergy. Exposure to exogenous histamine also induced LPR, mediated mainly by eosinophil-related mediators.     

枸杞多糖通过调控TLR9/AP-1信号通路对变应性鼻炎大鼠Th1/Th2细胞因子及鼻黏膜中嗜酸性粒细胞炎症的影响

目的 探究枸杞多糖通过调控Toll样受体9/激活蛋白-1(TLR9/AP-1)信号通路对变应性鼻炎大鼠Th1/Th2细胞因子、鼻黏膜中嗜酸性粒细胞炎症的影响。方法 选取60只SPF级SD雄性大鼠,随机分为正常(A)组,模型(B)组,糠酸莫米松(C)组,枸杞多糖(D)组,TLR9/AP-1信号通路抑制剂(E)组,TLR9/AP-1信号通路抑制剂联合枸杞多糖(F)组,每组各10只,对B、C、D、E、F组采用卵清蛋白致敏法建立变应性鼻炎模型,A组不建立该模型。建模成功后,对C组给予1喷/侧的糠酸莫米松喷鼻治疗,对D组灌胃100 mg/kg的枸杞多糖,对E组灌胃20 mg/kg AP-1抑制剂SP100030,对F组给予SP100030联合枸杞多糖,A、B组同期给予灌胃同体积生理盐水,对大鼠鼻部症状进行评分,HE染色法检测鼻黏膜组织病理形态及嗜酸性粒细胞并计数,ELISA法检测大鼠血清中Th1/Th2细胞因子水平,免疫印迹法检测鼻黏膜组织中TLR9/AP-1信号通路相关蛋白表达。结果 与A组相比,B组鼻部症状评分、鼻黏膜中嗜酸性粒细胞数目、血清IL-4含量显著升高(P<0.05),血清中INF-γ含量显著降低(P<0.05);与B组比较,C、D两组鼻部症状评分、鼻黏膜中嗜酸性粒细胞数目、血清IL-4含量显著降低(P<0.05),血清中INF-γ含量显著升高(P<0.05),且D组比C组变化显著(P＜0.05);A组大鼠鼻黏膜组织结构完整,B组鼻黏膜上皮结构紊乱且不完整,出血及嗜酸性粒细胞等炎性细胞浸润;与B组相比,C、D组病理状态明显改善,嗜酸性粒细胞明显减少;与A组比较,B组鼻黏膜组织中TLR9、AP-1蛋白表达显著升高(P<0.05),与B组比较,C、D组鼻黏膜组织中TLR9、AP-1蛋白表达显著降低(P<0.05),且D组比C组变化显著(P＜0.05),而E组与D组相比无明显差异(P＞0.05),F组比E组降低明显(P<0.05)。结论 枸杞多糖可有效调控变应性鼻炎大鼠Th1/Th2细胞因子水平、减轻鼻黏膜中嗜酸性粒细胞炎症,其机制可能与抑制TLR9/AP-1信号通路有关。     

Efficacy of Odiosoft-Rhino in assessment of nasal obstruction: a comparative study with acoustic rhinometry after treatment with budesonide nasal spray in patients with perennial allergic rhinitis

BACKGROUND: Odiosoft-Rhino (OR) is new software and equipment that can be used to measure changes in nasal obstruction after intranasal steroid treatment. OR is a promising method for measuring the degree of nasal obstruction. OR can precisely analyze nasal sound spectra in decibels, which is generated by nasal airflow. We studied the reliability of OR for assessing declining nasal obstruction after budesonide nasal spray treatment. METHODS: Sixty-five patients with perennial allergic rhinitis (PAR) were enrolled in the study, and 52 of these patients completed the study. Nasal endoscopic examination, acoustic rhinometry (AR), and OR were performed and symptom scores were compared before and after 3 months of treatment with intranasal budesonide. All of the patients received 7 days of placebo treatment before receiving budesonide. RESULTS: There was a significant difference in the visual analog scores of nasal obstruction and in the examination scores before and after the treatment for both the right and the left nasal cavities. Pretreatment AR findings and OR findings in the 2000- to 4000-Hz and 4000- to 6000-Hz intervals for both sides were significantly different from the posttreatment measurements (p = 0.000). Both AR and OR can assess the efficacy of budesonide nasal spray treatment for nasal obstruction in patients with PAR. CONCLUSION: Both AR and OR are effective for assessing nasal obstruction and monitoring treatment efficacy but, as a simple and noninvasive test, OR can be used with confidence.     

常年性变应性鼻炎患者鼻粘膜中粘蛋白MUC5AC的表达

目的 :探讨粘蛋白 MUC5 AC在常年性变应性鼻炎发病中的意义。方法 :采用 PAS染色和免疫组化 SABC法检测了 2 3例常年性变应性鼻炎患者鼻粘膜中粘蛋白 MUC5 AC的表达。结果 :2 3例变应性鼻炎鼻粘膜组织中 PAS染色均为阳性 ,粘蛋白 MU C5 AC染色阳性率为 85 .2 % ,主要表达在粘膜下腺体上皮的杯状细胞中。结论 :粘蛋白 MUC5 AC在常年性变应性鼻炎的过度分泌过程中具有重要的意义