Comparison of Allergen-Induced Late Inflammatory Reactions in the Nose and in the Skin in House Dust Mite-Allergic Patients with or without Asthma

Abstract

Background: It remains to be established which factors contribute to the occurrence of asthma in allergic individuals. We hypothesized that differences in the late allergic inflammatory reaction to allergen between asthmatic and non-asthmatic house dust mite-allergic individuals might contribute to the difference in the clinical presentation of allergy. Aim: To compare allergen-induced changes in parameters for cellular inflammation during the phase of the late allergic reaction in the skin and nose, in house dust mite-allergic individuals with or without asthma. Material and Methods: Nasal and dermal allergen challenges with house dust mite (Dermatophagoides pteronyssinus) extract were performed in 52 house dust mite-allergic individuals, of whom 26 had mild to moderate persistent asthma and 26 had perennial rhinitis without current or past asthmatic symptoms. Serial nasal lavage samples were analyzed for the presence of inflammatory cells (eosinophils and neutrophils) and soluble markers associated with cellular inflammation [interleukin-5 (IL-5), interleukin-8 (IL-8), eosinophil cationic protein (ECP) and myeloperoxidase (MPO)]. Macroscopic late phase skin reactions were studied after intracutaneous skin tests with house dust mite extract. Results: Fixed dose nasal allergen provocation elicited a similar degree of immediate allergic reaction as judged by plasma protein exudation and histamine concentrations in asthma and non-asthmatic rhinitis. Subsequently, no differences between groups were found during the phase of the late allergic reaction (4–24 h) in inflammatory cell influx, plasma protein leakage, ECP or MPO. Likewise, there were no differences in levels of chemotactic cytokines IL-5 and IL-8. In agreement with the results of nasal challenge, the late skin reaction after dermal challenge with a fixed allergen dose and after an allergen dose 10,000 times above the skin threshold for an early skin reaction did not differ between the groups. Conclusion: House dust mite-allergic patients with or without asthma have very similar late allergic inflammatory reactions in the skin and in the nose after allergen challenge. Hence, it is unlikely that the occurrence of pulmonary symptoms in asthma is explained by a general tendency of asthmatics to have an enhanced late allergic cellular inflammatory response. Nasal and dermal allergen provocations are adequate models to study allergen-induced inflammation but probably lack the pivotal link which is essential for the development of asthma.

Immediate and dual response to nasal challenge with Dermatophagoides pteronyssinus in local allergic rhinitis

“…A similar pattern of nasal release of ECP and sIgE‐DP was found in immediate and dual responders. The late response in allergic rhinitis has been associated with an influx of eosinophils [9, 10, 26, 30]. In our study, LAR patients sensitized to DP presented a significant nasal release of ECP starting at 15 min after provocation, with a progressive increase to the final point 24 h after a provocation challenge.…”

Nasal inflammatory mediators and specific IgE production after nasal challenge with grass pollen in local allergic rhinitis

“…These results reflect eosinophil activation during the immediate and late response to nasal challenge in patients with LAR, not just during the late response, as has been reported in atopic patients. 27,[29][30][31] An important finding of this study was the detection of significantly increased nasal levels of sIgE to grass pollen at 1, 6, and 24 hours after NAPT in 30% of the patients with LAR. This rapid nasal release of sIgE after nasal challenge, with the detection in some patients of baseline levels of sIgE to grass pollen out of spring, supports the existence of a persistent local synthesis of sIgE in nasal mucosa of patients with LAR that rapidly enhances after nasal exposure to aeroallergens.…”

“…9 The existence of a late response with recurrence of symptoms and release of inflammatory mediators after NAPT has been demonstrated by several authors in patients with allergic rhinitis with and without asthma. 14,17,[24][25][26][27] A late bronchial response after allergen inhalation in allergic asthma has also been reported in approximately 60% of asthmatic allergic subjects. 28 This response has been considered a more important sign of airway inflammation than the immediate allergic airway response.…”

Associations between pre-employment immunologic and airway mucosal factors and the development of occupational allergy

“…Nasal lavage was performed as described by Lopuhaa et al 10 Supernatants were stored at 2208C until analysis for the presence of myeloperoxidase, eosinophil cationic protein, a-2-macroglobulin, albumin, and IL-8. These assays were performed as described previously.…”

“…These assays were performed as described previously. [10][11][12] Lung function and bronchial hyperresponsiveness were measured according to previous guidelines. 13 FEV 1 and forced vital capacity values were expressed as percent predicted.…”