de Graaf-in't Veld C, Garrelds I M, van Toorenenbergen A W, Gerth van Wijk R
Department of Allergology, University Hospital, Rotterdam-Dijkzigt, The Netherlands.
Thorax. 1997 Feb;52(2):143-8. doi: 10.1136/thx.52.2.143.
In the lower airways an association has been found between early phase reaction (EPR), late phase reaction (LPR), and bronchial hyperreactivity. However, this association has not been shown for the upper airways in nasal pollen challenge studies. A study was undertaken to determine whether the EPR, LPR, and nasal hyperreactivity are related in perennial allergic rhinitis.
Twenty four patients with rhinitis who were allergic to house dust mite (HDM) were challenged with HDM extract. The nasal response was monitored by symptom scores and nasal lavages for up to 9.5 hours after challenge and concentrations of albumin, tryptase, and eosinophil cationic protein (ECP) in the lavage fluid were measured. Thirteen patients (defined as dual responders) had increased symptom scores between 3.5 and 9.5 hours compared with the baseline score. The other 11 patients (defined as early responders) showed an isolated EPR only. Nasal hyperreactivity was determined by nasal histamine challenge 24 hours later.
Dual responders showed a significantly higher symptom score, albumin influx, and tryptase release during the EPR. During the late phase (3.5-9.5 hours) albumin influx was significantly increased at most time points and ECP release was significantly higher at 9.5 hours in the dual responder group. Dual responders showed a significantly stronger response to all doses of histamine. The area under the curve (AUC) of symptom scores during EPR and LPR and the AUC of the histamine dose response were significantly correlated (EPR-LPR: r = 0.49, p < 0.01; EPR-histamine: r = 0.75, p < 0.001; LPR-histamine: r = 0.66, p < 0.001).
In patients with perennial allergic rhinitis the nasal responses to allergen and histamine are associated. Dual responders have an increased EPR, increased levels of mediators, and increased allergen-induced hyperreactivity.
在下呼吸道中，已发现早期反应（EPR）、晚期反应（LPR）与支气管高反应性之间存在关联。然而，在鼻花粉激发试验研究中，上呼吸道尚未显示出这种关联。开展了一项研究以确定EPR、LPR与常年性变应性鼻炎患者鼻高反应性之间是否相关。
对24例对屋尘螨（HDM）过敏的鼻炎患者进行HDM提取物激发试验。激发后长达9.5小时，通过症状评分和鼻腔灌洗监测鼻腔反应，并测定灌洗液中白蛋白、类胰蛋白酶和嗜酸性粒细胞阳离子蛋白（ECP）的浓度。13例患者（定义为双重反应者）在3.5至9.5小时之间的症状评分较基线评分增加。其他11例患者（定义为早期反应者）仅表现出孤立的EPR。24小时后通过鼻腔组胺激发试验测定鼻高反应性。
双重反应者在EPR期间症状评分、白蛋白流入和类胰蛋白酶释放显著更高。在晚期（3.5 - 9.5小时），双重反应者组在大多数时间点白蛋白流入显著增加，且在9.5小时ECP释放显著更高。双重反应者对所有剂量组胺的反应显著更强。EPR和LPR期间症状评分的曲线下面积（AUC）与组胺剂量反应的AUC显著相关（EPR - LPR：r = 0.49，p < 0.01；EPR - 组胺：r = 0.75，p < 0.001；LPR - 组胺：r = 0.66，p < 0.001）。
在常年性变应性鼻炎患者中，鼻腔对变应原和组胺的反应相关。双重反应者EPR增加、介质水平升高且变应原诱导的高反应性增加。
