White M V
Allergic Diseases Section, National Institute of Allergy and Infectious Diseases, Bethesda, Md.
J Allergy Clin Immunol. 1993 Aug;92(2):278-87. doi: 10.1016/0091-6749(93)90171-b.
Atopic individuals have previously been shown to have an autonomic imbalance consisting of heightened cholinergic responsiveness in the lung, skin, and eyes, and beta-adrenergic hyporesponsiveness in the lungs, eyes, and vasculature. This array of abnormalities is often accompanied by nonspecific bronchial hyperresponsiveness, as well as alpha-adrenergic hyperresponsiveness in individuals with asthma.
To determine whether atopic individuals have intrinsic nasal airway hyperresponsiveness to methacholine, 21 nonatopic subjects and 37 subjects with allergic rhinitis were studied. All subjects were studied out of their allergy seasons, and all allergy-related medications were discontinued before the study began. Subjects underwent nasal challenge with methacholine (1 to 25 mg), and lavaged nasal secretions were analyzed for total protein, the plasma marker albumin, and the glandular marker lactoferrin.
Atopic subjects demonstrated increased glandular responsiveness to methacholine as evidenced by an increase in the secretion of lactoferrin in response to individual doses of methacholine. Although the maximal lactoferrin secretion did not increase, glandular sensitivity to methacholine was heightened because the dose of methacholine required to induce lactoferrin secretion achievable by 60% of the study population was significantly lower in the atopic group. The volume of lavaged secretions recovered and congestion scores were also higher in the atopic group as compared with the normal control group.
These data strongly suggest that atopic individuals have intrinsic nasal glandular hyperresponsiveness to cholinergic stimulation.
先前的研究表明，特应性个体存在自主神经失衡，表现为肺、皮肤和眼睛的胆碱能反应性增强，以及肺、眼睛和血管系统的β-肾上腺素能反应性降低。这一系列异常通常伴有非特异性支气管高反应性，以及哮喘患者的α-肾上腺素能高反应性。
为了确定特应性个体是否对乙酰甲胆碱有内在的鼻气道高反应性，对21名非特应性受试者和37名变应性鼻炎患者进行了研究。所有受试者均在过敏季节之外进行研究，并且在研究开始前停用所有与过敏相关的药物。受试者接受乙酰甲胆碱（1至25毫克）的鼻腔激发试验，并对灌洗后的鼻分泌物进行总蛋白、血浆标志物白蛋白和腺体标志物乳铁蛋白的分析。
特应性受试者对乙酰甲胆碱的腺体反应性增加，这表现为对各剂量乙酰甲胆碱的反应中乳铁蛋白分泌增加。尽管乳铁蛋白的最大分泌量没有增加，但由于特应性组中诱导60%的研究人群可达到的乳铁蛋白分泌所需的乙酰甲胆碱剂量显著更低，因此腺体对乙酰甲胆碱的敏感性增强。与正常对照组相比，特应性组回收的灌洗分泌物量和充血评分也更高。
这些数据有力地表明，特应性个体对胆碱能刺激有内在的鼻腺高反应性。
