Firestone Institute for Respiratory Health and the Department of Medicine, McMaster University, Hamilton, ON, Canada.
Firestone Institute for Respiratory Health and the Department of Medicine, McMaster University, Hamilton, ON, Canada
Eur Respir J. 2015 Sep;46(3):819-31. doi: 10.1183/13993003.00536-2015. Epub 2015 Jul 23.
Environmental allergens are an important cause of asthma and can contribute to loss of asthma control and exacerbations. Allergen inhalation challenge has been a useful clinical model to examine the mechanisms of allergen-induced airway responses and inflammation. Allergen bronchoconstrictor responses are the early response, which reaches a maximum within 30 min and resolves by 1-3 h, and late responses, when bronchoconstriction recurs after 3-4 h and reaches a maximum over 6-12 h. Late responses are followed by an increase in airway hyperresponsiveness. These responses occur when IgE on mast cells is cross-linked by an allergen, causing degranulation and the release of histamine, neutral proteases and chemotactic factors, and the production of newly formed mediators, such as cysteinyl leukotrienes and prostaglandin D2. Allergen-induced airway inflammation consists of an increase in airway eosinophils, basophils and, less consistently, neutrophils. These responses are mediated by the trafficking and activation of myeloid dendritic cells into the airways, probably as a result of the release of epithelial cell-derived thymic stromal lymphopoietin, and the release of pro-inflammatory cytokines from type 2 helper T-cells. Allergen inhalation challenge has also been a widely used model to study potential new therapies for asthma and has an excellent negative predictive value for this purpose.
环境过敏原是哮喘的一个重要病因,并可能导致哮喘控制不佳和加重。过敏原吸入挑战已成为一种有用的临床模型,可用于研究过敏原引起的气道反应和炎症的机制。过敏原引起的气道收缩反应是早期反应,在 30 分钟内达到最大值,并在 1-3 小时内消退,而晚期反应则是在 3-4 小时后气道收缩再次发生并在 6-12 小时达到最大值。晚期反应后会出现气道高反应性增加。当过敏原交联肥大细胞上的 IgE 时,就会发生这些反应,导致脱颗粒和组胺、中性蛋白酶和趋化因子的释放,并产生新形成的介质,如半胱氨酰白三烯和前列腺素 D2。过敏原引起的气道炎症包括气道嗜酸性粒细胞、嗜碱性粒细胞和(不太常见)中性粒细胞的增加。这些反应是由髓样树突状细胞向气道的迁移和激活介导的,可能是由于上皮细胞衍生的胸腺基质淋巴细胞生成素的释放,以及 2 型辅助 T 细胞释放促炎细胞因子所致。过敏原吸入挑战也已成为研究哮喘潜在新疗法的广泛应用模型,并且具有出色的阴性预测值。
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