Zhu Zheng, Wang Hongyu, Xie Yanqing, An Jiaying, Hu Qiurong, Xia Shu, Li Jing, O'Byrne Paul, Zheng Jinping, Zhong Nanshan
Department of Allergy and Clinical Immunology, State Key Lab of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
State Key Lab of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
J Thorac Dis. 2021 Aug;13(8):4988-4998. doi: 10.21037/jtd-20-2876.
Allergen nasal challenge can induce increase of eosinophils in sputum, but report about eosinophilic inflammation in upper airway after allergen bronchial challenge in Chinese asthmatics was rare. The article aims to evaluate response of upper and lower airways to house dust mite (HDM) allergen bronchial challenge.
HDM allergen bronchial challenge was carried out in asthmatic patients with allergic rhinitis (AR). Bronchial methacholine challenge and blood test were performed before and at 24 hours after allergen challenge. Nasal lavage and induced sputum for differential cells count and fractional exhaled nitric oxide (FeNO) measurement were performed before, 7 and 24 hours after allergen challenge.
Eighteen asthmatic patients with AR underwent HDM allergen bronchial challenge with no serious adverse events reported. Fifteen patients showed dual asthmatic response (DAR), while 2 patients showed early (EAR) and 1 late asthmatic response (LAR) only. At 24 hours after allergen bronchial challenge testing, average PCFEV to methacholine significantly decreased (1.58 to 0.81 mg/mL, P=0.03), while both FeNO and the percentage of eosinophils in blood and sputum were significantly increased [52.0 (54.0) to 69.0 (56.0) ppb, P=0.01; 4.82% to 6.91%, P<0.001; 20.70% to 27.86%, P=0.03, respectively], but with no significant differences found in the percentage of eosinophils in nasal lavage (39.36% to 38.58%, P=0.89). However, at 7 hours after allergen challenge, the eosinophils in sputum were significant increased to 40.45% (P<0.001), but there was an increase (39.36% to 48.07%) with no statistical difference (P=0.167) found in nasal lavage.
HDM allergen bronchial challenge induced different response of airway inflammation in upper and lower airways.
变应原鼻激发试验可导致痰液中嗜酸性粒细胞增多，但关于中国哮喘患者变应原支气管激发试验后上呼吸道嗜酸性粒细胞炎症的报道较少。本文旨在评估上、下呼吸道对屋尘螨（HDM）变应原支气管激发试验的反应。
对合并变应性鼻炎（AR）的哮喘患者进行HDM变应原支气管激发试验。在变应原激发试验前及激发后24小时进行支气管乙酰甲胆碱激发试验和血液检查。在变应原激发试验前、激发后7小时和24小时进行鼻腔灌洗及诱导痰检查，以进行细胞分类计数和测定呼出一氧化氮分数（FeNO）。
18例合并AR的哮喘患者接受了HDM变应原支气管激发试验，未报告严重不良事件。15例患者出现双相哮喘反应（DAR），2例患者仅出现早发哮喘反应（EAR），1例出现迟发哮喘反应（LAR）。变应原支气管激发试验后24小时，乙酰甲胆碱激发试验的平均PCFEV显著降低（从1.58降至0.81mg/mL，P = 0.03），而FeNO、血液和痰液中嗜酸性粒细胞百分比均显著升高[分别从52.0（54.0）升至69.0（56.0）ppb，P = 0.01；从4.82%升至6.91%，P < 0.001；从20.70%升至27.86%，P = 0.03]，但鼻腔灌洗中嗜酸性粒细胞百分比无显著差异（从39.36%升至38.58%，P = 0.89）。然而，变应原激发试验后7小时，痰液中嗜酸性粒细胞显著增加至40.45%（P < 0.001），但鼻腔灌洗中有增加（从39.36%升至48.07%），差异无统计学意义（P = 0.167）。
HDM变应原支气管激发试验可诱发上、下呼吸道不同的气道炎症反应。
