Svensson C, Grönneberg R, Andersson M, Alkner U, Andersson O, Billing B, Gilljam H, Greiff L, Persson C G
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Lund, Sweden.
J Allergy Clin Immunol. 1995 Aug;96(2):239-46. doi: 10.1016/s0091-6749(95)70013-7.
Microvascular-epithelial exudation of bulk plasma may characterize inflammatory airway diseases. This study compares the acute allergen challenge-induced mast cell and exudative responses in nasal and bronchial airways. The focus is on alpha 2-macroglobulin as an index of luminal entry of plasma exudates.
Separate nasal and bronchial allergen challenges were carried out outside the pollen season in eight patients with pollen-induced seasonal allergic rhinitis. The levels of different-sized plasma proteins (albumin molecular weight, 66,000 d and alpha 2-macroglobulin molecular weight, 725,000 d) and tryptase were determined in pre- and postchallenge nasal lavage and bronchoalveolar lavage (BAL) fluids. Diluent and increasing doses of allergen were sprayed into the right nasal cavity, and each challenge was followed by a nasal lavage (volume, 15 ml) with a "nasal pool" device (recovery, > 80%). Endobronchial allergen challenge (individual doses) and BAL (volume, 2 x 25 ml) were performed in a lobe bronchus through a fiberoptic bronchoscope (recovery, 30%). Saline challenge and BAL were carried out in the contralateral lung as control.
The levels of albumin, alpha 2-macroglobulin, and tryptase increased dose-dependently in postchallenge nasal lavage fluids (p < 0.05) and correlated to nasal symptoms. In particular, albumin and alpha 2-macroglobulin correlated (r = 0.98, p < 0.001). Both alpha 2-macroglobulin and tryptase, but not albumin, were increased in BAL fluids from the allergen-challenged side (p < 0.05).
Local allergen challenge causes luminal entry of tryptase and alpha 2-macroglobulin in the nose and bronchi of patients with allergy. We suggest that mast cell and plasma exudation responses may be similar in human nasal and bronchial airways and that albumin levels (in BAL fluids) may not well reflect the exudation process in bronchial airways.
大量血浆的微血管 - 上皮渗出可能是炎症性气道疾病的特征。本研究比较了急性过敏原激发诱导的鼻和支气管气道中的肥大细胞和渗出反应。重点是α2 - 巨球蛋白作为血浆渗出物腔内进入的指标。
在花粉季节之外，对8例花粉诱导的季节性过敏性鼻炎患者进行了单独的鼻和支气管过敏原激发试验。在激发前和激发后的鼻灌洗液和支气管肺泡灌洗（BAL）液中测定不同大小血浆蛋白（白蛋白分子量66,000 d和α2 - 巨球蛋白分子量725,000 d）和类胰蛋白酶的水平。将稀释剂和递增剂量的过敏原喷入右侧鼻腔，每次激发后用“鼻池”装置进行鼻灌洗（体积15 ml）（回收率> 80％）。通过纤维支气管镜在叶支气管中进行支气管内过敏原激发（个体剂量）和BAL（体积2×25 ml）（回收率30％）。在对侧肺中进行盐水激发和BAL作为对照。
激发后鼻灌洗液中白蛋白、α2 - 巨球蛋白和类胰蛋白酶水平呈剂量依赖性增加（p <0.05），并与鼻部症状相关。特别是，白蛋白和α2 - 巨球蛋白相关（r = 0.98，p <0.001）。过敏原激发侧的BAL液中α2 - 巨球蛋白和类胰蛋白酶均增加，但白蛋白未增加（p <0.05）。
局部过敏原激发导致过敏患者鼻和支气管中类胰蛋白酶和α2 - 巨球蛋白进入管腔。我们认为人类鼻和支气管气道中的肥大细胞和血浆渗出反应可能相似，并且（BAL液中的）白蛋白水平可能不能很好地反映支气管气道中的渗出过程。
