Bonavia M, Crimi E, Quaglia A, Brusasco V
Divisione di Pneumologia Ospedale di Pietra Ligure, Savona, Italy.
Eur Respir J. 1996 May;9(5):905-9. doi: 10.1183/09031936.96.09050905.
Allergic rhinitic subjects without symptoms of asthma show airway hyperresponsiveness, but to a lesser degree than asthmatics. As airway responsiveness is a determinant of the bronchial response to allergen, rhinitic subjects should also respond to allergen challenge, but to a lesser extent than asthmatics. However, studies have so far failed to show quantitative differences in allergen responses between patients with rhinitis and patients with asthma. We studied 123 allergic subjects classified, on the basis of a scored symptom questionnaire, as follows: pure rhinitics without any symptom of asthma (Group 1, n = 39), true asthmatics with or without rhinitis (Group 2, n = 41), and subjects with borderline symptoms of asthma (Group 3, n = 43). All subjects underwent both methacholine and allergen inhalation challenges, with pollen challenges performed out of season. When the three groups were pooled, the asthma symptom score was directly correlated with the sensitivities both to methacholine and allergen, whilst both the sensitivity to allergen and the severity of late-phase response were correlated with the sensitivity to methacholine. The percentage of subjects with a positive early-phase asthmatic response to allergen was similar in Groups 1 and 2. Group 2 had higher sensitivities both to methacholine and to allergen than Group 1. A late-phase asthmatic response occurred more frequently in Group 2 than in Group 1, and this difference was due to a higher occurrence of late-phase response in subjects allergic to house dust mite in Group 2. This study confirms that the bronchial response to allergen can be predicted, in rhinitic as well as in asthmatic allergic subjects, on the basis of airway responsiveness to methacholine. We conclude that the presence or the absence of asthma symptoms in allergic subjects may be related to a quantitatively different airway responsiveness to allergen.
无哮喘症状的变应性鼻炎患者存在气道高反应性，但程度低于哮喘患者。由于气道反应性是支气管对变应原反应的一个决定因素，鼻炎患者也应对变应原激发产生反应，但程度低于哮喘患者。然而，迄今为止的研究未能显示鼻炎患者和哮喘患者在变应原反应方面的定量差异。我们研究了123名变应性受试者，根据症状评分问卷将其分类如下：无任何哮喘症状的单纯鼻炎患者（第1组，n = 39）、有或无鼻炎的真正哮喘患者（第2组，n = 41）以及有哮喘临界症状的受试者（第3组，n = 43）。所有受试者均接受了乙酰甲胆碱和变应原吸入激发试验，花粉激发试验在非花粉季节进行。当将三组合并时，哮喘症状评分与对乙酰甲胆碱和变应原的敏感性直接相关，而对变应原的敏感性和迟发相反应的严重程度均与对乙酰甲胆碱的敏感性相关。第1组和第2组中对变应原出现早期哮喘反应阳性的受试者百分比相似。第2组对乙酰甲胆碱和变应原的敏感性均高于第1组。第2组迟发相哮喘反应的发生率高于第1组，这种差异是由于第2组中对屋尘螨过敏的受试者迟发相反应发生率较高所致。本研究证实，在鼻炎和哮喘变应性受试者中，可根据气道对乙酰甲胆碱的反应性来预测支气管对变应原的反应。我们得出结论，变应性受试者中哮喘症状的有无可能与气道对变应原的反应性在数量上的差异有关。
