Zhu Zheng, Xie Yanqing, Guan Weijie, Gao Yi, Xia Shu, Huang Rongquan, Zhong Nanshan, Zheng Jinping
State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
Clin Respir J. 2018 Feb;12(2):587-594. doi: 10.1111/crj.12566. Epub 2016 Nov 1.
Both histamine and leukotrienes are implicated in the pathogenesis of allergic rhinitis (AR), although the pattern and severity of the nasal response to these two potent inflammatory mediators may differ, which has not been adequately studied in patients with persistent AR.
We sought to compare the differential effects of nasal challenge with leukotriene D (LTD ) and histamine on the airway response and inflammation in patients with AR.
An open-label, crossover study was performed in 25 persistent AR patients (AR group) and 16 healthy subjects (control group). Participants randomly underwent histamine and LTD nasal provocation within a two-week interval. Nasal symptoms according to a visual analogue scale (VAS), fractional exhaled nitric oxide (FENO), nasal lavage, induced sputum, and spirometry were evaluated before and after nasal challenge.
Nasal airway resistance (NAR) increased significantly after both LTD and histamine nasal challenge in AR patients (P < .05). The potency of LTD was 142-fold higher than that of histamine in increasing NAR (P < .001). The nasal symptom score induced by histamine challenge was significantly higher than that triggered by LTD (3.42 ± 0.83 vs. 1.16 ± 0.94, P < .05) in the AR group. LTD and histamine nasal challenge led to a significant increase in neutrophils in the nasal lavage and induced sputum (P < .05) in AR patients. There were no significant differences in the changes of eosinophils before and after LTD4 and histamine nasal challenges in nasal lavage and induced sputum. No significant changes in NAR, the induced symptom score, or inflammatory cells in the nasal lavage and sputum were found in the control group.
LTD and histamine nasal challenge caused different patterns and severities of nasal symptoms, which correlated with symptoms (TSS) that affect patient's daily life. LTD4 was far more potent than histamine at increasing the NAR, while histamine nasal challenge induced more sneezing and nasal discharge. These results may guide the prescription of anti-histamine or anti-leukotriene agents for treating different AR phenotypes.
组胺和白三烯均与变应性鼻炎（AR）的发病机制有关，尽管鼻腔对这两种强效炎症介质的反应模式和严重程度可能不同，但在持续性AR患者中对此尚未进行充分研究。
我们试图比较白三烯D（LTD）和组胺鼻腔激发试验对AR患者气道反应和炎症的不同影响。
对25例持续性AR患者（AR组）和16例健康受试者（对照组）进行了一项开放标签、交叉研究。参与者在两周内随机接受组胺和LTD鼻腔激发试验。在鼻腔激发试验前后，根据视觉模拟量表（VAS）评估鼻症状、呼出一氧化氮分数（FENO）、鼻腔灌洗、诱导痰和肺功能。
AR患者在LTD和组胺鼻腔激发试验后鼻气道阻力（NAR）均显著增加（P < 0.05）。在增加NAR方面，LTD的效力比组胺高142倍（P < 0.001）。在AR组中，组胺激发试验诱发的鼻症状评分显著高于LTD激发试验（3.42±0.83 vs. 1.16±0.94，P < 0.05）。LTD和组胺鼻腔激发试验导致AR患者鼻腔灌洗和诱导痰中的中性粒细胞显著增加（P < 0.05）。在鼻腔灌洗和诱导痰中，LTD4和组胺鼻腔激发试验前后嗜酸性粒细胞的变化无显著差异。对照组的NAR、诱导症状评分或鼻腔灌洗和痰液中的炎症细胞均无显著变化。
LTD和组胺鼻腔激发试验引起的鼻症状模式和严重程度不同，这与影响患者日常生活的症状（TSS）相关。LTD4在增加NAR方面比组胺有效得多，而组胺鼻腔激发试验诱发更多的打喷嚏和流涕。这些结果可能指导抗组胺药或抗白三烯药治疗不同AR表型的处方。
