University of Cincinnati, Ohio, USA.
Allergy Asthma Proc. 2012 Jul-Aug;33(4):333-40. doi: 10.2500/aap.2012.33.3579. Epub 2012 Jul 3.
Nonallergic rhinitis (NAR) subjects present clinically with similar symptoms to subjects with allergic rhinitis, but which mechanistically are not IgE- mediated. NAR is difficult to study because of multiple, as yet unknown, disease mechanisms and lack of biomarkers and diagnostic tests. The purpose of this proof of concept pilot study was to develop an environmental exposure chamber (EEC) model to simulate weather conditions in a controlled setting to objectively diagnose NAR subjects and ultimately to investigate novel NAR therapies. Thirty-seven subjects with a history of NAR confirmed by negative skin-prick test to a panel of aeroallergens were tested with cold dry air (CDA) and temperature change challenges. Objective (acoustic rhinometry [AcR] and nasal secretions) and subjective measures (total nasal symptom scores [TNSSs]: congestion, rhinorrhea, and postnasal drip [0-3]) were collected. Data was presented as mean ± SEM and statistical significance was assessed by paired t-test. The NAR EEC AcR responders to CDA had a significant decrease in mean minimal cross-sectional area (MCA; a measure of nasal patency) of 22.2 ± 2.43% (p < 0.0001) and 6.7 ± 7.22% (not statistically significant) at 30 and 60 minutes, respectively, with a concomitant increase in TNSS of 1.0 ± 0.24 U and 1.4 ± 0.30 U, respectively. AcR responders to temperature change showed a significant decrease in mean MCA to warm air of 16.0 ± 3.82% (p < 0.001) and 19.4 ± 3.88% (p < 0.0001) at 30 and 60 minutes, respectively, with an increase of TNSS of 0.4 ± 0.25 U and 0.4 ± 0.27 U, respectively. With rapid conversion to cold air, further decrease in mean MCA accompanied by an increase in TNSS was observed at 30 and 60 minutes. Increase in rhinorrhea was highest for CDA and the cold air phase of the temperature change challenge. Using the NAR EEC model, significant symptoms were induced in response to simulated weather changes in NAR patient responders. This proof of concept pilot study shows that the EEC model provides a consistent and reliable method to phenotype weather-induced NAR subjects that could be used to investigate disease mechanisms and novel therapies for NAR.
非过敏性鼻炎（NAR）患者的临床表现与过敏性鼻炎患者相似，但机制上并非 IgE 介导的。由于多种未知的疾病机制以及缺乏生物标志物和诊断测试，NAR 很难研究。本概念验证性先导研究的目的是开发一种环境暴露室（EEC）模型，以在受控环境中模拟天气条件，客观诊断 NAR 患者，并最终研究新型 NAR 疗法。37 名经皮肤点刺试验对一组气传过敏原呈阴性的 NAR 病史患者接受了冷干空气（CDA）和温度变化挑战。采集了客观（声鼻测量法 [AcR] 和鼻分泌物）和主观测量值（总鼻症状评分 [TNSS]：鼻塞、流涕和后鼻滴注 [0-3]）。数据以平均值 ± SEM 表示，通过配对 t 检验评估统计学意义。对 CDA 有反应的 NAR EEC AcR 患者的最小横截面积（MCA；衡量鼻通畅度的指标）平均值分别显著下降 22.2 ± 2.43%（p < 0.0001）和 6.7 ± 7.22%（无统计学意义），分别在 30 分钟和 60 分钟时，同时 TNSS 分别增加 1.0 ± 0.24 U 和 1.4 ± 0.30 U。对温度变化有反应的 AcR 患者的 MCA 对暖空气的平均值显著下降，分别为 16.0 ± 3.82%（p < 0.001）和 19.4 ± 3.88%（p < 0.0001），分别在 30 分钟和 60 分钟时，同时 TNSS 分别增加 0.4 ± 0.25 U 和 0.4 ± 0.27 U。快速转换为冷空气后，在 30 分钟和 60 分钟时观察到 MCA 平均值进一步下降，并伴有 TNSS 增加。CDA 和温度变化挑战的冷空气阶段的流涕增加最为明显。使用 NAR EEC 模型，在 NAR 患者应答者中，模拟天气变化引起了明显的症状。本概念验证性先导研究表明，EEC 模型为表型天气诱导的 NAR 患者提供了一种一致且可靠的方法，可用于研究疾病机制和新型 NAR 疗法。
