Polosa R, Li Gotti F, Mangano G, Mastruzzo C, Pistorio M P, Crimi N
Dipartimento di Medicina Interna e Specialistica, University of Catania, Catania, Italy.
Clin Exp Allergy. 2003 Jul;33(7):873-81. doi: 10.1046/j.1365-2222.2003.01676.x.
Bronchial hyper-responsiveness (BHR) is documented in a proportion of non-asthmatic individuals with allergic rhinitis (NAAR) and reflects inflammatory events in the lower airways. Natural exposure to allergens is known to modulate BHR and the level of airway inflammation in asthma, but less consistently in NAAR. Specific immunotherapy (SIT) attenuates symptoms possibly by reducing BHR and airway inflammation. The influence of natural exposure to Parietaria pollen on BHR and sputum cell counts of NAAR was investigated and the effect of Parietaria SIT examined. Thirty NAAR, monosensitized to Parietaria judaica, participated in a randomized, double-blind, placebo-controlled, parallel group study of the effects of a Parietaria pollen vaccine on symptoms/medication score, BHR to inhaled methacholine and adenosine 5'-monophosphate (AMP), and cell counts in the sputum collected out of and during the pollen seasons for 36 months. Seasonal variation in BHR to inhaled methacholine and AMP and changes in sputum cell counts were documented. Changes were consistent for AMP, but not methacholine, and invariably associated with modifications in sputum eosinophils and epithelial cells. The clinical efficacy of Parietaria SIT was associated with a decline in the seasonal deterioration of BHR to AMP, whereas no significant effect was observed on BHR to methacholine or sputum cell differentials. Between-groups comparison of the seasonal changes in PC15 methacholine values and sputum cell differentials calculated as the AUC were not statistically significant, whereas a significant difference in PC15 AMP was demonstrated throughout the study (P=0.029), the median (inter-quartile range) AUC values being 2478.5 (1153.3-3600.0) and 1545.5 (755.3-1797.9) for the SIT- and placebo-treated group, respectively. Bronchial airways of NAAR exhibit features of active inflammation that deteriorate during natural allergen exposure, particularly with regard to BHR to AMP. The clinical efficacy of Parietaria SIT was exclusively associated with attenuation in seasonal worsening of PC15 AMP, suggesting that AMP may be useful in monitoring changes in allergic inflammation of the airways.
支气管高反应性（BHR）在部分患有变应性鼻炎的非哮喘个体（NAAR）中得到证实，反映了下呼吸道的炎症事件。已知自然暴露于变应原可调节哮喘患者的BHR和气道炎症水平，但在NAAR中情况不太一致。特异性免疫疗法（SIT）可能通过降低BHR和气道炎症来减轻症状。本研究调查了自然暴露于墙草花粉对NAAR的BHR和痰液细胞计数的影响，并检验了墙草SIT的效果。30名单一致敏于犹太墙草的NAAR患者参与了一项随机、双盲、安慰剂对照的平行组研究，该研究为期36个月，观察了墙草花粉疫苗对症状/药物评分、对吸入乙酰甲胆碱和5'-单磷酸腺苷（AMP）的BHR以及在花粉季节期间及过后收集的痰液细胞计数的影响。记录了对吸入乙酰甲胆碱和AMP的BHR的季节性变化以及痰液细胞计数的变化。AMP的变化是一致的，但乙酰甲胆碱的变化并非如此，且这些变化总是与痰液嗜酸性粒细胞和上皮细胞的改变相关。墙草SIT的临床疗效与对AMP的BHR季节性恶化程度的下降有关，而对乙酰甲胆碱的BHR或痰液细胞分类未见显著影响。以PC15乙酰甲胆碱值和计算为AUC的痰液细胞分类的季节性变化的组间比较无统计学意义，而在整个研究中PC15 AMP显示出显著差异（P = 0.029），SIT治疗组和安慰剂治疗组的中位数（四分位间距）AUC值分别为2478.5（1153.3 - 3600.0）和1545.5（755.3 - 1797.9）。NAAR的支气管气道表现出活动性炎症特征，在自然暴露于变应原期间会恶化，特别是对于对AMP的BHR。墙草SIT的临床疗效仅与PC15 AMP季节性恶化的减轻有关，这表明AMP可能有助于监测气道变应性炎症的变化。
