Effects of intensity of early response to allergen on the late phase of both the nose and skin.

Thirty-seven asymptomatic ragweed-sensitive patients and ten controls were challenged both epicutaneously and intranasally with ragweed. Clinical assessments of both early (20 minutes) and late (six hours) phase reactions of skin (mm) and nose (clinical score) were performed. A positive routine nasal challenge was defined as a clinical score 5 (0-12). Augmented nasal challenges were 10-fold higher than routine for each patient. Nasal lavage was performed at baseline, after positive challenge, one, two, and six hours postchallenge. Mediators assayed included histamine, eosinophil cationic protein (ECP), leukotrine C4 (LTC4), and prostaglandin D2 (PGD2). All 37 patients had an early skin reaction. Only 28/37 had a late response correlating with the early. Twenty-one patients had routine nasal challenges; 14 then volunteered for an augmented challenge. The remaining 16 had augmented challenges only. All had a nasal clinical early response, but late responses were infrequent (9). The early phase PGD2 was higher in augmented compared with routine challenges (P < .05) as were the late histamine (P < .05) and ECP (P < .05). The early skin test correlated with early LTC4 (P < .001) and PGD2 (P < .05). The early and late LTC4 (P < .05) and PGD2 (P < .01) were also related. In summary, late phase reactions of both the nose and skin are related to the intensity of the early response.