Alvarez Puebla María J, Castillo Rodolfo, Rey Agustin, Ortega Nancy, Blanco Carlos, Carrillo Teresa
Department of Allergy, Hospital de León, León, Spain.
Chest. 2002 Nov;122(5):1560-5. doi: 10.1378/chest.122.5.1560.
To study the existence of bronchial disease among rhinitis patients. To evaluate the laboratory test or set of tests (ie, symptoms, exposure, and sensitization to the allergen, and the provocative dose of methacholine [Mth] causing a 20% fall in FEV(1) [PD(20)] and the maximal response plateau [MRP] to Mth) that best identifies a case of mild asthma.
Cross-sectional analysis in 52 Dermatophagoides pteronyssinus-monosensitized patients who were consulting a physician for perennial rhinitis.
Allergy Department, Hospital Doctor Negrín, Las Palmas, Grand Canary Island, Spain.
Patients filled out a standardized asthma symptom questionnaire, and underwent sputum induction and Mth challenge in which 40% falls in FEV(1) were attained. Dose-response curves were expressed in terms of both PD(20) values and the level of the MRP. D pteronyssinus allergen exposure was assessed in dust samples from patients' beds.
No difference between patients who positively responded to the questionnaire and those who did not was observed. Mth-PD(20) values were not detected in 13% of the patients reporting bronchial symptoms, and an MRP was not identified in 59% of the subjects who did not respond positively. A higher degree of allergen sensitization (ascertained from skin test results, and total and specific serum IgE levels) and higher degree of sputum eosinophilia were detected in subjects in whom an MRP had not been identified. The presence of sputum eosinophilia provided the best differentiation between those patients who presented with an MRP and those who did not.
The individual perception of bronchial symptoms is highly variable among perennial allergic rhinitis patients. The lack of a maximal airway-narrowing plateau is related to the presence of sputum eosinophilia, which might be useful in the detection of patients susceptible to anti-inflammatory therapy. Prospective studies evaluating whether these patients are more likely to develop symptomatic asthma in the future and if the early anti-inflammatory treatment prevents its development are needed.
研究鼻炎患者中支气管疾病的存在情况。评估实验室检查或一组检查（即症状、暴露情况、对过敏原的致敏情况，以及引起第一秒用力呼气容积（FEV₁）下降20%的乙酰甲胆碱（Mth）激发剂量[PD₂₀]和对Mth的最大反应平台[MRP]），以最佳识别轻度哮喘病例。
对52名因常年性鼻炎就诊的单一对尘螨过敏患者进行横断面分析。
西班牙大加那利岛拉斯帕尔马斯内格林医生医院过敏科。
患者填写标准化哮喘症状问卷，并接受痰液诱导和Mth激发试验，试验中FEV₁下降了40%。剂量反应曲线用PD₂₀值和MRP水平表示。通过患者床上灰尘样本评估尘螨过敏原暴露情况。
对问卷有阳性反应的患者与无阳性反应的患者之间未观察到差异。13%报告有支气管症状的患者未检测到Mth-PD₂₀值，59%无阳性反应的受试者未识别出MRP。在未识别出MRP的受试者中，检测到更高程度的过敏原致敏（根据皮肤试验结果、总血清IgE和特异性血清IgE水平确定）和更高程度的痰液嗜酸性粒细胞增多。痰液嗜酸性粒细胞增多的存在为有MRP的患者和无MRP的患者提供了最佳区分。
常年性过敏性鼻炎患者对支气管症状的个体感知差异很大。缺乏最大气道狭窄平台与痰液嗜酸性粒细胞增多有关，这可能有助于检测易患抗炎治疗的患者。需要进行前瞻性研究，评估这些患者未来是否更易发展为有症状的哮喘，以及早期抗炎治疗是否能预防其发展。
