Baroody Fuad M, Mucha Samantha M, Detineo Marcy, Naclerio Robert M
Section of Otolaryngology-Head and Neck Surgery, the Pritzker School of Medicine, the University of Chicago, Chicago, IL 60637, USA.
J Allergy Clin Immunol. 2008 May;121(5):1126-1132.e7. doi: 10.1016/j.jaci.2008.02.010. Epub 2008 Mar 26.
Allergic rhinitis and chronic rhinosinusitis are both characterized by chronic inflammation.
We sought to investigate the effect of nasal allergen challenge on the maxillary sinus and study the effect of premedication with loratadine.
We performed a double blind, crossover, randomized, placebo-controlled study in 20 allergic subjects out of season. After treatment with either placebo or loratadine (10 mg PO daily) for 1 week, a catheter was inserted into one maxillary sinus and used to lavage the cavity. The subjects then underwent nasal challenge with diluent for the allergen extract, followed by 3 concentrations of grass or ragweed. Nasal and ipsilateral sinus lavages were performed after each challenge and then hourly for 8 hours. Sneezes and symptoms were recorded, and the lavage specimens were evaluated for eosinophils and levels of eosinophil cationic protein, albumin, and histamine. Eleven of the subjects underwent a similar challenge with lactated Ringer's solution.
Compared with the lactated Ringer's solution challenge, allergen challenge resulted in significant increases in most early- and late-phase nasal parameters. Allergen challenge of the nose also led to a significant increase compared with control values in maxillary sinus eosinophils and the levels of albumin, eosinophil cationic protein, and histamine during the late response. Loratadine resulted in significant inhibition of the nasal early response compared with that seen with placebo (P < .05).
These findings suggest that a neural reflex or systemic allergic inflammation is responsible for the sinus inflammatory response and that this inflammatory response might play a role in the development of rhinosinusitis in allergic subjects.
变应性鼻炎和慢性鼻-鼻窦炎均以慢性炎症为特征。
我们旨在研究鼻内变应原激发对上颌窦的影响，并探讨氯雷他定预处理的作用。
我们在非发病季节对20名变应性受试者进行了一项双盲、交叉、随机、安慰剂对照研究。在用安慰剂或氯雷他定（每日口服10 mg）治疗1周后，将一根导管插入一侧上颌窦并用于冲洗窦腔。然后受试者用变应原提取物的稀释液进行鼻激发，随后用3种浓度的草或豚草进行激发。每次激发后进行鼻和同侧鼻窦冲洗，然后每小时冲洗1次，共冲洗8小时。记录喷嚏和症状，并对冲洗标本进行嗜酸性粒细胞及嗜酸性粒细胞阳离子蛋白、白蛋白和组胺水平的评估。11名受试者用乳酸林格液进行了类似的激发。
与乳酸林格液激发相比，变应原激发导致大多数早期和晚期鼻参数显著增加。与对照值相比，鼻内变应原激发还导致上颌窦嗜酸性粒细胞以及晚期反应期间白蛋白、嗜酸性粒细胞阳离子蛋白和组胺水平显著增加。与安慰剂相比，氯雷他定导致鼻早期反应受到显著抑制（P <.05）。
这些发现表明，神经反射或全身性变应性炎症是鼻窦炎症反应的原因，并且这种炎症反应可能在变应性受试者鼻-鼻窦炎的发生中起作用。
