Shusterman Dennis J, Tilles Stephen A
Department of Medicine, University of Washington, Seattle, Washington, USA.
Am J Rhinol Allergy. 2009 Sep-Oct;23(5):475-9. doi: 10.2500/ajra.2009.23.3348.
Noninfectious nonallergic rhinitis (NINAR) is characterized by self-reported hyperreactivity to nonspecific physical or chemical stimuli. The relationship between these two classes of triggers is not well established, however. We compared NINAR subjects with predominantly physical or chemical triggers versus normal controls with respect to subjective (symptomatic) and objective (obstructive) responses to cold, dry air challenge.
We studied 14 NINAR subjects and 10 normal controls. Exposures consisted of 15 minutes of cold dry air (0 degrees C/5% RH) or warm moist air (25 degrees C/50% RH) on two separate days a week apart. Subjects rated symptoms using visual analog scales and had their nasal airway resistance measured at baseline, immediately after, and at 15-minute intervals for 1 hour postexposure.
The majority of NINAR subjects reported physical triggers as more troublesome than chemical. Immediately postprovocation, the mean net proportional change in nasal airway resistance from baseline was +0.18 in NINAR (physical), +0.05 in NINAR (chemical), and -0.01 in control subjects (NS). However, a pooled linear regression by number of physical triggers (0-5) revealed a 7.5% increase in cold air-induced nasal airway resistance per trigger reported (p<0.05). Similarly, raising the criterion number of physical triggers from >or=1 to >or=2 also distinguished NINAR subjects from controls in a bivariate analysis.
Either considering self-reported physical triggers as a continuous scale (0-5) or requiring more physical triggers (>or=2 rather than >or=1) to define NINAR successfully predicts objective nasal reactivity to cold air provocation.
非感染性非过敏性鼻炎（NINAR）的特征是自我报告对非特异性物理或化学刺激的高反应性。然而，这两类触发因素之间的关系尚未完全明确。我们比较了以物理或化学因素为主导触发因素的NINAR患者与正常对照者对冷干空气激发试验的主观（症状性）和客观（阻塞性）反应。
我们研究了14名NINAR患者和10名正常对照者。暴露包括在每周相隔一天的两天中，分别暴露于15分钟的冷干空气（0摄氏度/5%相对湿度）或暖湿空气（25摄氏度/50%相对湿度）中。受试者使用视觉模拟量表对症状进行评分，并在基线、暴露后立即以及暴露后1小时内每隔15分钟测量一次鼻气道阻力。
大多数NINAR患者报告物理因素比化学因素更麻烦。激发试验后立即测量，NINAR（物理因素）组鼻气道阻力相对于基线的平均净比例变化为+0.18，NINAR（化学因素）组为+0.05，对照组为-0.01（无统计学差异）。然而，根据报告的物理触发因素数量（0 - 5）进行的汇总线性回归显示，每报告一个触发因素，冷空气诱导的鼻气道阻力增加7.5%（p<0.05）。同样，在双变量分析中，将物理触发因素的标准数量从≥1提高到≥2也能区分NINAR患者和对照组。
将自我报告的物理触发因素视为连续量表（0 - 5）或要求更多的物理触发因素（≥2而非≥1）来定义NINAR，都能成功预测对冷空气激发试验的客观鼻反应性。
