Inflammatory effect of environmental proteases on airway mucosa.

Proteases--both endogenous proteases from the coagulation cascade, mast cells, and respiratory epithelial trypsin, and exogenous proteases from parasites, insects, mites, molds, pollens, and other aeroallergens--stimulate a tissue response that includes attraction and activation of eosinophils and neutrophils, degranulation of eosinophils and mast cells, increased response of afferent neurons, smooth muscle contraction, angiogenesis, fibrosis, and production of immunoglobulin E. This response to exogenous proteases can be considered a form of innate immunity directed against multicellular organisms. The response of the airways to environmental proteases very closely resembles the response to airborne allergens. Although clinical research in this area is just beginning, the response to environmental proteases appears to be important in the pathogenesis of rhinitis and asthma developing from damp, water-damaged buildings, and intrinsic asthma with its associated rhinosinusitis and polyps.