Neurogenic inflammation in skin and airways.

Neurogenic inflammation, in its original definition, the plasma leakage induced by stimulation of peripheral sensory nerves, occurs in the postcapillary venules of the skin and airways. Plasma leakage is accompanied by increased blood flow, which results from dilatation of arterioles. In skin, these phenomena are manifested as wheal and flare, respectively. Both phenomena are mediated by neuropeptides released from capsaicin-sensitive unmyelinated sensory nerve fibers. Substance P is the primary mediator responsible for plasma leakage, acting via tachykinin NK-1 receptors, whereas both calcitonin gene-related peptide and substance P induce vasodilatation. Sensory nerve transmitters also cause release of histamine from mast cells, which contributes substantially to plasma leakage in the skin, but less so in the airways. Substance P causes an increase in vascular permeability as a result of the focal, transient, and fully reversible formation of gaps, approximately 0.5 to 1.5 microns in diameter, located in the intercellular junctions of endothelial cells. The gaps can be visualized by silver nitrate staining of the endothelial cell borders, by lectin staining, or by scanning and transmission electron microscopy. Neurogenic inflammation can be inhibited by preventing the stimulation of sensory nerves, by presynaptic inhibition of neuropeptide release from sensory nerves, or by blocking neuropeptide receptors. The formation of endothelial gaps can also be inhibited by anti-inflammatory drugs that stabilize endothelial cells, such as beta-adrenergic agonists and steroids.