Nielsen L P, Bjerke T, Christensen M B, Pedersen B, Rasmussen T R, Dahl R
Department of Respiratory Diseases, University Hospital of Aarhus, Denmark.
Clin Exp Allergy. 1996 Nov;26(11):1268-75.
Seasonal allergic rhinitis constitutes an excellent in vivo model of an allergic mucosal inflammatory reaction. This offers the opportunity of studying the fundamentals of allergic inflammation in addition to improvement of knowledge on the basal pathophysiological mechanisms of the disease. So far, monitoring methods of disease activity and treatment efficacy have mainly been based upon subjective assessments, illustrating the impact of introducing reliable objective methods.
To investigate the allergic inflammatory reaction of seasonal rhinitis through different objective methods and evaluate these as indicators of disease activity and treatment efficacy.
Functional parameters, i.e. acoustic rhinometry and nasal metacholine challenge, and biological markers, i.e. blood eosinophil count, eosinophil cationic protein in serum (s-ECP) and nasal lavage fluid (n-ECP), were assessed before and at peak pollen season in 27 patients with grass pollen induced rhinitis. Patients were randomized to either nasal corticosteroid or placebo treatment and recorded nasal symptom scores.
Acoustic rhinometry revealed a significant difference in favour of steroid treatment (P < 0.05) comparing nasal volumes before and during season. This difference primarily relied upon a decrease in the placebo group (P = 0.05). A reduction from baseline of s-ECP in the steroid group (P < 0.01) was obtained. N-ECP demonstrated a difference between treatment groups, although not significant. Symptom scores increased in all patients during the pollen season, although this was only significant in the placebo treated patients (P < 0.01). The remaining methods applied did not demonstrate further differences, either within or between treatment groups.
Our results demonstrate acoustic rhinometry to be a sensitive and objective method of assessment of nasal obstruction. Furthermore, acoustic rhinometry and s-ECP reflect the impact of nasal steroid therapy on seasonal allergic rhinitis.
季节性变应性鼻炎是变应性黏膜炎症反应的理想体内模型。这不仅为研究变应性炎症的基本原理提供了机会，还能增进对该疾病基础病理生理机制的了解。到目前为止，疾病活动度和治疗效果的监测方法主要基于主观评估，这凸显了引入可靠客观方法的重要性。
通过不同的客观方法研究季节性鼻炎的变应性炎症反应，并将这些方法评估为疾病活动度和治疗效果的指标。
对27例草花粉诱发鼻炎的患者，在花粉季节前和花粉高峰期评估其功能参数，即鼻声反射和鼻乙酰甲胆碱激发试验，以及生物学标志物，即血嗜酸性粒细胞计数、血清嗜酸性粒细胞阳离子蛋白（s-ECP）和鼻灌洗液嗜酸性粒细胞阳离子蛋白（n-ECP）。患者被随机分为鼻用糖皮质激素治疗组或安慰剂治疗组，并记录鼻部症状评分。
鼻声反射显示，与季节前相比，季节中鼻腔容积在激素治疗组有显著差异（P<0.05），有利于激素治疗。这种差异主要是由于安慰剂组鼻腔容积减小（P = 0.05）。激素治疗组s-ECP较基线水平降低（P<0.01）。n-ECP显示治疗组间存在差异，尽管不显著。在花粉季节，所有患者的症状评分均升高，尽管仅在安慰剂治疗的患者中具有统计学意义（P<0.01）。所应用的其他方法在治疗组内或治疗组间均未显示出进一步差异。
我们的结果表明，鼻声反射是评估鼻阻塞的一种敏感且客观的方法。此外，鼻声反射和s-ECP反映了鼻用糖皮质激素治疗对季节性变应性鼻炎的影响。
