Godthelp T, Holm A F, Blom H, Klein-Jan A, Rijntjes E, Fokkens W J
Department of Otorhinolaryngology, Erasmus University, Rotterdam, The Netherlands.
Allergy. 1995;50(23 Suppl):21-4. doi: 10.1111/j.1398-9995.1995.tb02737.x.
Mast cell degranulation, and the subsequent recruitment of infiltrating inflammatory cells, such as eosinophils, into the nasal mucosa has long been considered the most important model to explain allergic rhinitis. Several studies show a decrease in the number of eosinophils and possibly also mast cells during local corticosteroid treatment. Over the last decade, a new model to explain allergic inflammation has evolved. In this model, Langerhans' cells and T-cells play an important role. Langerhans' cells possess a high affinity receptor for IgE. In patients with allergic rhinitis, allergen provocation results in stimulation of T-cells by the IgE-positive Langerhans' cells. The T-cells produce a number of cytokines which stimulate IgE production as well as the inflammatory reaction. The number of T-cells is not usually influenced by corticosteroid treatment; however, the function of the T-cells, shown by the spectrum of cytokines produced, is clearly influenced. The cells that are most dramatically affected by local corticosteroid treatment are the Langerhans' cells, which completely disappear during treatment. This decrease suggests that there is a reduction in antigen presentation. The subsequent decrease in T-cell stimulation may result in a reduction of the reactions that are dependent on T-cell-derived mediators.
长期以来，肥大细胞脱颗粒以及随后浸润性炎症细胞（如嗜酸性粒细胞）募集至鼻黏膜一直被认为是解释变应性鼻炎的最重要模型。多项研究表明，局部使用皮质类固醇治疗期间，嗜酸性粒细胞数量减少，肥大细胞数量可能也会减少。在过去十年中，一种解释变应性炎症的新模型逐渐形成。在这个模型中，朗格汉斯细胞和T细胞发挥着重要作用。朗格汉斯细胞拥有IgE高亲和力受体。在变应性鼻炎患者中，变应原激发会导致IgE阳性的朗格汉斯细胞刺激T细胞。T细胞产生多种细胞因子，这些细胞因子会刺激IgE产生以及炎症反应。T细胞数量通常不受皮质类固醇治疗的影响；然而，从所产生的细胞因子谱来看，T细胞的功能显然受到影响。受局部皮质类固醇治疗影响最显著的细胞是朗格汉斯细胞，其在治疗期间会完全消失。这种减少表明抗原呈递减少。随后T细胞刺激的减少可能会导致依赖T细胞衍生介质的反应减少。
