Nasal AMP and histamine challenge within and outside the pollen season in patients with seasonal allergic rhinitis - 10/08/11
Reprint requests: Brian Lipworth, MD, Asthma and Allergy Research Group, Centre for Cardiovascular and Lung Biology, University of Dundee, Dundee DD1 9SY, Scotland, United Kingdom.Abstract |
Background |
Nasal hyperreactivity is a prominent feature of allergic rhinitis. Variation in nasal hyperreactivity with different challenge agents in and out of the pollen season has not been examined.
Objective |
We sought to compare nasal hyperreactivity with different challenge agents before, during, and after the pollen season.
Methods |
Grass pollen–monosensitized patients performed cumulative-dose challenges with nasal AMP (25-800 mg · mL−1) and histamine (0.25-8 mg · mL−1) before, during, and after the grass pollen season. Outcomes included the provocative concentration of agent causing a 30% decrease in the peak nasal inspiratory flow (PNIF) (PC30), recovery profile, and diary cards.
Results |
Nineteen participants completed per protocol. AMP PC30 values for PNIF worsened by 1.33 (95% CI, 0.20-2.44; P = .02) doubling dilutions during the season but recovered after the season. The AMP recovery curve showed a −14.39% difference (95% CI, −21.11% to −7.66%; P < .001) during the season and remained abnormal after the season (−8.05% [95% CI, −14.78% to −1.33%; P < .05). Histamine PC30 values did not change during the season, but recovery was prolonged by −14.47% (95% CI, −22.19% to −6.76%, P < .001), returning to baseline values after the season. Nasal symptoms, domiciliary PNIF, and serum eosinophil-derived neurotoxin levels returned to baseline values after the season.
Conclusions |
There is a reduction in AMP PC threshold but not histamine PC threshold during the pollen season, indicating that AMP is a more sensitive indicator of allergic inflammation. The residual hyperreactivity to nasal AMP, but not histamine, outside of the pollen season, seen as a persistently prolonged recovery curve, suggests the presence of primed airway mucosal mast cells, even in asymptomatic patients, and persistent activation of mediator pathways, such as cysteinyl leukotrienes.
Le texte complet de cet article est disponible en PDF.Key words : Nasal hyperreactivity, nasal provocation, adenosine monophosphate, histamine, peak nasal inspiratory flow rate, nasal airway resistance
Abbreviations used : DD, EDN, NAR, PC30/PC60, PNIF, TNSS
Plan
| Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest. |
Vol 127 - N° 1
P. 173 - janvier 2011 Retour au numéro
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