Vidian nerve resection, histamine turnover and mucosal mast cell function in patients with chronic hypertrophic non-allergic rhinitis

Abstract

Parasympathetic innervation of the respiratory tract of nasal mucosa plays an important role in the pathogenesis of chronic hypertrophic non-allergic rhinitis (C.H.N.A.R.), the vidian nerve providing the main parasympathetic nerve supply to respiratory mucosa. The present study investigates the effect of vidian nerve resection in 22 patient with intractable C.H.N.A.R. on histamine content and formation and on the number of mast cells and their degranulation in the respiratory tract. Samples were taken from respiratory mucosa for histamine and histidine-decarboxylase assay, and for microscopic observations for mast cell density and degranulation index, before and 12-24 months after vidian nerve resection. Neurectomy of the vidian nerve completely cured the clinical symptomatology, evaluated by rhinoreomanometry, and also significantly decreased both the high histamine levels and histidine-decarboxylase activity in patients with C.H.N.A.R. The density and degranulation index of mast cells were also significantly lower after surgery. These data suggest a relationship between cholinergic activity and the secretory response of mast cells and indicates a correlation between the parasympathetic nerve supply and chronic hyperthrophic non-allergic rhinitis. The significant reduction in mast cell density, histamine levels and histidine-decarboxylase activity also lends support to the hypothesis that the parasympathetic nerve supply plays a role in the regulation of mast cell histamine.

Role of Parasympathetic Nerves and Muscarinic Receptors in Allergy and Asthma

“…Mast cell recruitment is also associated with parasympathetic signaling. Cutting the parasympathetic supply to the nose significantly reduced mast cell density in the respiratory mucosa [138]. …”

“…In contrast, an in vivo study of nasal allergy showed parasympathetic signaling might promote mast cell histamine release. When cutting the vidian nerve supplying parasympathetic nerves to the nose in patients with rhinitis, both the density of mast cells and histamine concentration in the nose were significantly reduced [138]. …”

Mechanisms and mediators of nasal symptoms in non‐allergic rhinitis

“…A cholinergic link between vidian nerve stimulation and the observed release of histamine is further suggested by the reported inhibitory effect of atropine, and the potentiating effect of eserine on histamine release [68]. Vidian nerve section, as well as inducing a reduction in the secretory activity of the glands and vasoconstriction of the venous plexuses [72, 73], also appears to induce a significant decrease in histamine tissue levels and histidine decarboxylase activity [70]. This is associated with a reduction in density and in the degranulation index of mast cells [70].…”

“…Vidian nerve section, as well as inducing a reduction in the secretory activity of the glands and vasoconstriction of the venous plexuses [72, 73], also appears to induce a significant decrease in histamine tissue levels and histidine decarboxylase activity [70]. This is associated with a reduction in density and in the degranulation index of mast cells [70]. In this context, histamine released from mucosal mast cells by cholinergic stimulation could enhance the parasympathetic response of glands and vessels.…”

Effects of flutropium on experimental models of drug- and allergy-induced rhinitis in guinea pigs.

“…These re sults suggest that the vagal reflex plays an im portant role in various airway responses. It is known that the parasympathetic innervation of nasal mucosa plays an important role in the rhinitis (13). Flutropium bromide (flutropium) is a new antiasthma drug possessing the quartemary ammonium salt structure of an atropine derivative.…”