Nakai Y, Ohashi Y, Tanaka A, Kakinoki Y, Washio Y, Masamoto T, Yamada K, Nakai Y, Ohmoto Y
Department of Otolaryngology, Osaka City University Medical School, Japan.
Acta Otolaryngol Suppl. 1998;538:143-51.
This study comprised 130 adult patients with Japanese cedar pollen-specific IgE in the serum and 15 non-atopic individuals. Eighteen patients had no seasonal aggravation of nasal symptoms during the pollen season in 1998 (asymptomatic group). Forty-two patients had not been treated previously with immunotherapy and were treated with antihistamine tablets during the pollen season in 1998 (medication group). Sixty-one patients had undergone variable periods of immunotherapy using pollen extracts, and they were further divided into a good-IT group who responded markedly to immunotherapy and a poor-IT group who responded poorly to immunotherapy. The remaining nine patients had been treated with immunotherapy for more than 12 years and all of them had stopped immunotherapy by the end of May 1997 because they had no nasal symptoms for the last three pollen seasons and were considered to be cured of seasonal allergic rhinitis (cure group). Peripheral blood mononuclear cells (PBMCs) were collected from each subject during the cedar pollen season in 1998 and were stimulated for 96 h with 10 micrograms/ml Cry j 1. The concentrations of interleukin-5 (IL-5) and interferon-gamma (IFN-gamma) in the culture supernatant were determined using an enzyme-linked immunosorbent assay. The levels of IFN-gamma did not differ significantly among the non-atopic group, the asymptomatic group, the medication group, the poor-IT group and the good-IT group. The level of IL-5 in the asymptomatic group was not different from that in the non-atopic group. The levels of IL-5 in the medication group, the good-IT group and the poor-IT group were significantly higher than in the non-atopic group. The level of IL-5 in the good-IT group, but not in the poor-IT group, was significantly lower than in the medication group. The level of IL-5 in the cure group was not significantly different from in the non-atopic group, and the level of IFN-gamma in the cure group was significantly lower than in the non-atopic group. In conclusion, immunotherapy can decrease the pollen allergen-induced synthesis of IL-5, but not of IFN-gamma, and this immunological modulation is involved in the working mechanism of immunotherapy related to its clinical efficacy. A tolerance or anergy of both TH1 and TH2 cells under allergen stimulation may be an immunological indication of cure after the treatment of seasonal allergic rhinitis. Thus, the suppression of synthesis of IL-5 and IFN-gamma by allergen-stimulated PBMCs is likely to be a reliable criterion for a possible cure of seasonal allergic rhinitis after immunotherapy.
本研究纳入了130例血清中含有日本雪松花粉特异性IgE的成年患者和15例非特应性个体。1998年花粉季节期间，18例患者鼻部症状无季节性加重（无症状组）。42例患者此前未接受过免疫治疗，于1998年花粉季节期间服用抗组胺药进行治疗（药物治疗组）。61例患者接受了不同疗程的花粉提取物免疫治疗，他们又被进一步分为免疫治疗反应良好的良好免疫治疗组和免疫治疗反应不佳的不佳免疫治疗组。其余9例患者接受免疫治疗超过12年，截至1997年5月底，他们均已停止免疫治疗，因为在过去三个花粉季节中他们均无鼻部症状，被认为已治愈季节性变应性鼻炎（治愈组）。1998年雪松花粉季节期间从每位受试者采集外周血单个核细胞（PBMC），并用10微克/毫升的Cry j 1刺激96小时。使用酶联免疫吸附测定法测定培养上清液中白细胞介素-5（IL-5）和干扰素-γ（IFN-γ）的浓度。非特应性组、无症状组、药物治疗组、不佳免疫治疗组和良好免疫治疗组之间IFN-γ水平无显著差异。无症状组IL-5水平与非特应性组无差异。药物治疗组、良好免疫治疗组和不佳免疫治疗组的IL-5水平显著高于非特应性组。良好免疫治疗组的IL-5水平显著低于药物治疗组，但不佳免疫治疗组并非如此。治愈组的IL-5水平与非特应性组无显著差异，治愈组的IFN-γ水平显著低于非特应性组。总之，免疫治疗可降低花粉变应原诱导的IL-5合成，但不能降低IFN-γ合成，这种免疫调节作用参与了免疫治疗与其临床疗效相关的作用机制。变应原刺激下TH1和TH2细胞的耐受或无反应可能是季节性变应性鼻炎治疗后治愈的免疫指标。因此，变应原刺激的PBMC对IL-5和IFN-γ合成的抑制可能是免疫治疗后季节性变应性鼻炎可能治愈的可靠标准。
