Meyer Peter, Andersson Morgan, Persson Carl G A, Greiff Lennart
Department of Pediatrics, University Hospital, Lund, Sweden.
Pediatr Allergy Immunol. 2003 Feb;14(1):60-5. doi: 10.1034/j.1399-3038.2003.02102.x.
Previous studies involving adults have demonstrated that airway glucocorticosteroids inhibit plasma exudation and eosinophil activity in allergic rhinitis. This study explores the possibility that plasma exudation, exudative responsiveness, and the occurrence of eosinophil activity-related proteins are glucocorticosteroid-sensitive nasal mucosal indices in allergic children. Using a placebo-controlled, parallel-group design effects of nasal budesonide (64 microg per nasal cavity b.i.d) were determined in children with seasonal allergic rhinitis. Nasal lavage fluid levels of eotaxin, eosinophil cationic protein (ECP), and alpha2-macroglobulin, indicating plasma exudation, were determined, the latter with and without challenge with topical histamine. Nasal lavage fluid levels of alpha2-macroglobulin and ECP increased significantly during the pollen season, and the acute plasma exudation response to histamine was significantly greater during than outside the season. There was a trend towards a seasonal increase in nasal lavage fluid levels of eotaxin. Budesonide significantly inhibited the seasonal increase in alpha2-macroglobulin as well as the exudative hyperresponsiveness to histamine. Any tendency of increases in mucosal output of eotaxin and ECP was abolished by the glucocorticosteroid treatment. We conclude that mucosal exudation of plasma, as a global sign of active inflammatory processes, is a glucocorticosteroid-sensitive facet of allergic rhinitis in children. Exudative hyperresponsiveness, potentially caused by several weeks of mucosal inflammation, emerges as a significant feature of allergic rhinitis in children, and its development is prevented by local treatment with a glucocorticosteroid drug. The seasonal increase in ECP and the trend for an increase in eotaxin were absent in the glucocorticosteroid-treated subjects.
以往针对成年人的研究表明,气道糖皮质激素可抑制变应性鼻炎中的血浆渗出及嗜酸性粒细胞活性。本研究探讨血浆渗出、渗出反应性以及嗜酸性粒细胞活性相关蛋白的出现是否为变应性儿童中糖皮质激素敏感的鼻黏膜指标。采用安慰剂对照、平行组设计,确定了布地奈德鼻喷雾剂(每侧鼻腔64μg,每日两次)对季节性变应性鼻炎儿童的作用。测定了鼻灌洗液中嗜酸性粒细胞趋化因子、嗜酸性粒细胞阳离子蛋白(ECP)和α2-巨球蛋白的水平,以指示血浆渗出情况,其中α2-巨球蛋白在局部组胺激发前后均进行了测定。花粉季节期间,鼻灌洗液中α2-巨球蛋白和ECP水平显著升高,且对组胺的急性血浆渗出反应在花粉季节期间显著大于非花粉季节。鼻灌洗液中嗜酸性粒细胞趋化因子水平有随季节升高的趋势。布地奈德显著抑制了α2-巨球蛋白的季节性升高以及对组胺的渗出性高反应性。糖皮质激素治疗消除了嗜酸性粒细胞趋化因子和ECP黏膜分泌增加的任何趋势。我们得出结论,作为活跃炎症过程的整体标志,血浆的黏膜渗出是儿童变应性鼻炎中糖皮质激素敏感的一个方面。渗出性高反应性可能由数周的黏膜炎症引起,是儿童变应性鼻炎的一个显著特征,局部使用糖皮质激素药物可预防其发展。在接受糖皮质激素治疗的受试者中,ECP的季节性升高以及嗜酸性粒细胞趋化因子升高的趋势并不存在。