Failla M, Biondi G, Provvidenza Pistorio M, Gili E, Mastruzzo C, Vancheri C, Crimi N
Department of Internal and Specialistic Medicine, Section of Respiratory Medicine, University of Catania, Catania, Italy.
Clin Exp Allergy. 2006 Mar;36(3):325-30. doi: 10.1111/j.1365-2222.2006.02449.x.
Allergic rhinitis (AR) precedes and is often associated with bronchial asthma. Indeed, local and systemic inflammations in both conditions are very similar. Cysteinyl-leukotrienes (cys-LTs) are generated during early- and late-phase allergic reactions and induce smooth-muscle contraction, microvascular leakage, and mucous hypersecretion. Cys-LTs are detected in exhaled breath condensate (EBC) of asthmatics and regardless of bronchial symptoms, they are also found in EBC of rhinitic patients.
To evaluate cys-LTs in EBC of allergic patients and to assess the activity of nasal fluticasone propionate (FP) on EBC cys-LTs levels.
Cys-LTs coefficient of variation (CV) was evaluated from different EBC in 5 healthy volunteers. Cys-LTs levels from EBCs in 13 healthy controls and 56 allergic rhinitic (n=31) and rhinitic/asthmatic (n=25) patients were also evaluated at baseline. Subsequently patients were randomized to receive either FP 100 microg/day per nostril or placebo for 2 weeks and then re-evaluated for EBC cys-LTs.
The CV was 14.12%. EBC cys-LTs in allergic patients were significantly higher than in healthy subjects (70.9 vs. 20.6 pg/mL (median), P<0.05), while it did not differ between asthmatic/rhinitic and purely rhinitic patients. Treatment significantly reduced cys-LTs (from 93.6 to 19.9 pg/mL, P<0.001). This effect was evident both in asthmatic/rhinitic and in rhinitic patients.
Treatment of AR with FP significantly reduces the levels of cys-LTs, major noninvasive markers of lower airway inflammation, suggesting that upper and lower airway inflammation is present and should be thus treated as a whole in subjects with AR with and without asthma.
变应性鼻炎（AR）先于支气管哮喘出现且常与之相关。实际上，这两种疾病的局部和全身炎症非常相似。半胱氨酰白三烯（cys-LTs）在速发和迟发过敏反应中产生，并诱导平滑肌收缩、微血管渗漏和黏液分泌亢进。在哮喘患者的呼出气冷凝液（EBC）中可检测到cys-LTs，并且无论有无支气管症状，在鼻炎患者的EBC中也能发现。
评估变应性患者EBC中的cys-LTs，并评估丙酸氟替卡松（FP）对EBC中cys-LTs水平的作用。
对5名健康志愿者不同EBC中的cys-LTs变异系数（CV）进行评估。还在基线时评估了13名健康对照者以及56名变应性鼻炎患者（n = 31）和鼻炎/哮喘患者（n = 25）EBC中的cys-LTs水平。随后，将患者随机分为两组，分别接受每侧鼻孔每日100μg FP或安慰剂治疗2周，然后再次评估EBC中的cys-LTs。
CV为14.12%。变应性患者EBC中的cys-LTs显著高于健康受试者（中位数分别为70.9 vs. 20.6 pg/mL，P<0.05），而哮喘/鼻炎患者与单纯鼻炎患者之间无差异。治疗后cys-LTs显著降低（从93.6降至19.9 pg/mL，P<0.001）。这种效应在哮喘/鼻炎患者和鼻炎患者中均很明显。
用FP治疗AR可显著降低cys-LTs水平，cys-LTs是下气道炎症的主要非侵入性标志物，这表明在有或无哮喘的AR患者中，上、下气道均存在炎症，因此应将其作为一个整体进行治疗。
