Kirmaz Cengiz, Degirmenci Papatya B, Tunali Didem, Yuksel Hasan
Division of Allergy and Immunology, Department of Internal Medicine, Celal Bayar University Medical Faculty, Manisa, Turkey.
Ann Allergy Asthma Immunol. 2007 Jun;98(6):524-32. doi: 10.1016/S1081-1206(10)60730-2.
Allergic rhinitis (AR) is an allergic inflammatory disease in which allergen exposure leads to the appearance of symptoms in sensitized individuals because of histamine liberation from nasal mucosal mast cells. Comorbidity of this disease with allergic asthma is common. Therefore, the one airway one disease theory has been put forward. Lower respiratory tract provocation tests with both nonspecific (methacholine) and specific stimulants (allergen) have yielded positive results in nonasthmatic patients with AR. However, not enough research is available to demonstrate whether there is a response in the lower respiratory tract during nasal provocation tests (NPTs) performed to evaluate only nasal airway in these patients.
To determine if the lower respiratory tract was affected as a result of NPTs with nonspecific and specific stimulants in nonasthmatic patients with AR and to determine the frequency of lower respiratory tract obstruction due to NPT with nonspecific and specific stimulants.
Thirty-six participants were enrolled in the study between November 2005 and January 2006 (18 AR patients and 18 healthy control subjects). Patients underwent 2 sessions of NPT. The first session was performed with nasal methacholine as a nonspecific stimulant, and the second session was performed with nasal Olea europaea extract as a specific stimulant. The control group underwent only nonspecific nasal provocation with methacholine. Basal nasal opening and nasal pressures were evaluated spirometrically by rhinomanometric measurements and basal respiratory function tests in both groups before methacholine nasal provocation. Whether or not nasal provocation was achieved, spirometric measurements were performed in all patients and controls after NPTs.
NPTs with methacholine resulted in a similar frequency of nasal provocation in the patient and control groups (P = .63). However, the mean methacholine dose was lower in patients with AR (P = .049). There was a decrease in parameters of asthma, including the ratio of forced expiratory volume in 1 second to forced vital capacity (P = .04), peak expiratory flow (P = .01), and forced expiratory flow between 25% and 75% (P = .004), as a result of NPTs with methacholine in the patient group. However, NPTs with allergen did not cause a change in lower respiratory tract obstruction criteria.
Lower respiratory tract obstruction can occur after NPTs with nonspecific stimulants; therefore, tests performed with specific allergens can be regarded as safer.
变应性鼻炎（AR）是一种变应性炎症性疾病，在致敏个体中，变应原暴露会因鼻黏膜肥大细胞释放组胺而导致症状出现。这种疾病与变应性哮喘合并存在很常见。因此，提出了“一个气道，一种疾病”的理论。对非哮喘性AR患者进行非特异性（乙酰甲胆碱）和特异性刺激物（变应原）的下呼吸道激发试验均得到了阳性结果。然而，尚无足够的研究来证明在仅评估这些患者鼻气道的鼻激发试验（NPT）过程中，下呼吸道是否会出现反应。
确定非哮喘性AR患者进行非特异性和特异性刺激物的NPT后下呼吸道是否受到影响，并确定非特异性和特异性刺激物的NPT导致下呼吸道阻塞的频率。
2005年11月至2006年1月期间，36名参与者纳入研究（18名AR患者和18名健康对照者）。患者接受2次NPT。第一次试验使用鼻用乙酰甲胆碱作为非特异性刺激物，第二次试验使用鼻用油橄榄提取物作为特异性刺激物。对照组仅接受乙酰甲胆碱的非特异性鼻激发试验。在乙酰甲胆碱鼻激发试验前，通过鼻阻力测量和基础呼吸功能测试，以肺量计测量法评估两组的基础鼻通气口和鼻压力。无论是否实现鼻激发，在NPT后对所有患者和对照者进行肺量计测量。
乙酰甲胆碱的NPT在患者组和对照组中导致鼻激发的频率相似（P = 0.63）。然而，AR患者的平均乙酰甲胆碱剂量较低（P = 0.049）。患者组中，乙酰甲胆碱的NPT导致哮喘参数下降，包括1秒用力呼气容积与用力肺活量之比（P = 0.04）、呼气峰值流速（P = 0.01）以及25%至75%之间的用力呼气流量（P = 0.004）。然而，变应原的NPT并未引起下呼吸道阻塞标准的变化。
非特异性刺激物的NPT后可能会出现下呼吸道阻塞；因此，使用特异性变应原进行的试验可被视为更安全。
