Ciprandi Giorgio, Ricciardolo Fabio Luigi Massimo, Schiavetti Irene, Cirillo Ignazio
1Istituto di Ricovero e Cura a Carattere Scientifico-Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
Am J Rhinol Allergy. 2014 Nov-Dec;28(6):214-8. doi: 10.2500/ajra.2014.28.4124.
Allergic rhinitis (AR) and asthma may be associated, bronchial hyperreactivity (BHR) is quite common in AR patients. Methacholine (MCH) is a stimulus able to elicit BHR, as many other ones. Phenotyping AR is an up-to-date issue.
The aim of this study was to evaluate whether MCH bronchial challenge is able to differentiate patients with AR.
A total of 298 patients (277 males, mean age 28.9 years), suffering from AR were evaluated. Sensitization, rhinitis duration, values for bronchial function (forced vital capacity [FVC], forced expiratory volume [FEV]1, forced expiratory flow [FEF]25-75, and FEV1/FVC ratio), MCH bronchial challenge, visual analog scale (VAS) for nasal and bronchial symptoms perception, and fractioned exhaled nitric oxide (FeNO) were evaluated.
BHR-positive patients (22.8%) had significantly more frequent mite allergy (p = 0.025), longer AR duration (p < 0.001), lower FEV1 (p = 0.003), FEV1/FVC (p < 0.001), FEF25-75 (p < 0.001), higher (p < 0.001), and higher VAS values for both nasal and bronchial symptoms (p < 0.001 for both) in comparison with BHR-negative patients. FeNO can be considered a good predictor for BHR in AR patients (area under the curve, 0.90) with 27.0 ppb as cutoff.
The present study demonstrates that BHR to MCH could define two distinct phenotypes in AR patients. It could be clinically relevant as BHR-positive patients have initial impairment of lung function, impaired FeNO values, and worsening of respiratory symptoms perception.
变应性鼻炎（AR）与哮喘可能相关，支气管高反应性（BHR）在AR患者中相当常见。与许多其他刺激物一样，乙酰甲胆碱（MCH）是一种能够引发BHR的刺激物。对AR进行表型分析是一个最新的课题。
本研究旨在评估MCH支气管激发试验是否能够区分AR患者。
共评估了298例AR患者（277例男性，平均年龄28.9岁）。评估了致敏情况、鼻炎病程、支气管功能值（用力肺活量[FVC]、第1秒用力呼气容积[FEV]1、用力呼气流量[FEF]25-75以及FEV1/FVC比值）、MCH支气管激发试验、用于评估鼻和支气管症状的视觉模拟量表（VAS）以及呼出一氧化氮分数（FeNO）。
与BHR阴性患者相比，BHR阳性患者（22.8%）的螨过敏更为频繁（p = 0.025），AR病程更长（p < 0.001），FEV1更低（p = 0.003），FEV1/FVC更低（p < 0.001），FEF25-75更低（p < 0.001），FeNO更高（p < 0.001），并且鼻和支气管症状的VAS值更高（两者均p < 0.001）。FeNO可被认为是AR患者BHR的良好预测指标（曲线下面积为0.90），以27.0 ppb作为截断值。
本研究表明，对MCH的BHR可在AR患者中定义两种不同的表型。这可能具有临床相关性，因为BHR阳性患者存在肺功能的初始损害、FeNO值受损以及呼吸症状感知恶化。
