Low levels of interferon-gamma in nasal fluid accompany raised levels of T-helper 2 cytokines in children with ongoing allergic rhinitis

The Impact of Cytokines on Health-Related Quality of Life in Adolescents with Allergic Rhinitis

BACKGROUND

Frequent episodes of nasal symptoms are the usual clinical manifestations (CM) of allergic rhinitis (AR) and have a significant negative impact on health-related quality of life (HRQoL) in adolescents. The purpose of this cross-sectional study was to test the hypothesis that cytokines in nasal mucus may be associated with HRQoL in adolescents with AR.

METHODS

European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), "The Adolescent Rhinoconjunctivitis Quality of Life Questionnaire" (AdolRQLQ) and the Total 4 Symptom Score (T4SS) scoring system were administered to 113 adolescents with AR, nonallergic rhinitis (NAR) and to healthy control subjects. Nasal secretions were sampled and tested for 13 cytokines using a multiplex flow cytometric bead assay.

RESULTS

The AR group had significantly lower EQ-5D-3L (0.661 ± 0.267 vs. 0.943 ± 0.088; p < 0.001) and higher AdolRQLQ total scores (2.76 ± 1.01 vs. 1.02 ± 0.10; p < 0.001) compared to the control group. The AR group had higher concentrations of IL-1β (p = 0.002), IL-6 (p = 0.031), IL-8 (p < 0.001), IL17-A (p = 0.013) and IL-18 (p = 0.014) compared to the control group, and IL-1β, IL-6, IL17-A and IL-18 were significantly (p < 0.050) increased with disease progression. Cytokines IL-1β, IL-6, as well as severe CM, were identified as significant predictors of lower HRQoL in adolescents with AR.

CONCLUSIONS

This study identified IL-1β, IL-6, as well as severe CM, as predictors of lower HRQoL in adolescents with AR. However, these results should only serve as a starting point for additional confirmation research.

Analysis of Cytokine Production Profiles of Local and Systemic Lymphocytes in Sick Building Syndrome Compared with Ocular Allergy

Purpose

We have previously studied clinical and allergological aspects of sick building syndrome (SBS) cases with ocular disorders and found that SBS is suggested to be partially induced by an allergic response. We analyzed the cytokine production profiles of conjunctival and peripheral blood lymphocytes in patients with SBS with ocular manifestations to further evaluate the pathophysiology of SBS from an immunological standpoint.

Methods

We obtained conjunctival samples and peripheral blood mononuclear cells (PBMC) from 15 cases of SBS with ocular findings, 49 cases of allergic conjunctival diseases (ACD) (allergic conjunctivitis (AC), atopic keratoconjunctivitis (AKC), and vernal keratoconjunctivitis (VKC)), and normal controls. Frequencies of cytokine-producing T cells were analyzed by flow cytometry based on an intracellular cytokine staining method.

Results

Although no significant difference was observed in the percentage of interferon (IFN)-γ-producing CD4+ T cells in PBMC between patients with SBS and controls, the percentage of interleukin (IL)-4-producing PBMC CD4+ T cells in patients with SBS was significantly higher than that in controls. The percentage of IL-4-producing CD4+ T cells in the conjunctiva in patients with SBS was significantly higher than that in controls, whereas it was significantly lower than that in AKC and VKC. A significant correlation was observed between the percentage of IL-4-producing CD4+ T cells in the conjunctiva and clinical score.

Conclusion

These results suggest that SBS may be a kind of allergic disorder and that IL-4 plays a role in the development of allergic disorders in SBS ocular lesions.

Cetirizine Decreases Interleukin-4, Interleukin-5, and Interferon-γ Gene Expressions in Nasal-Associated Lymphoid Tissue of Sensitized Mice

Although the action of cetirizine dihydrochloride (cetirizine), a potent histamine H1 receptor antagonist, has been well known, its effect on the cytokine profiles in the nasal immune inductive site has not been elucidated yet. We studied the effect of cetirizine on the cytokine profiles in the nasal-associated lymphoid tissue (NALT), which is a principal mucosal lymphoid tissue of the respiratory tract in rodents. Two different doses of cetirizine were given intraorally for 5 days before the nasal challenge of ovalbumin in sensitized mice. The sensitized group was given normal saline instead of cetirizine, and the nonsensitized group had no sensitization or medication. The cytokine gene expressions in the NALT taken from the mice were investigated with real-time quantitative reverse-transcription polymerase chain reaction. The effect of cetirizine on the allergic symptom score, histamine threshold, and the eosinophil count in the nasal septal mucosa were examined also. Compared with the normal mice, the sensitized mice showed significantly increased levels of interleukin (IL)-4 and IL-5 gene expression although the increase of interferon (INF)-γ gene expression was not significant. In the cetirizine groups, the levels of expression of IL-4, IL-5, and INF-γ in the NALT were significantly decreased compared with the sensitized group. The cetirizine groups also showed decreased allergic symptom score, histamine threshold, and eosinophil count in the nasal septal mucosa compared with the sensitized group. In conclusion, cetirizine reduced the levels of expression of IL-4, IL-5, and INF-γ in the NALT of ovalbumin-sensitized mice. Cetirizine also reduced the acute allergic symptom, histamine sensitivity, and eosinophil count in the nasal septal mucosa.

The Relationship between Th1/Th2 Balance and 1α, 25-Dihydroxyvitamin D3 in Patients with Allergic Rhinitis

Objective

With regard to the correlation between T helper1/T helper2 (Th1/Th2) cell balance and 1α,25-dihydroxyvitamin D₃, active metabolite of vitamin D, we studied Th1/Th2 cell balance by measuring levels of the cytokines interleukin (IL)-4, IL-10 and interferon-gamma (IFN-γ), which are important for immune response of patients with allergic rhinitis.

Methods

Thirty adult patients diagnosed with allergic rhinitis (study group) and 40 healthy volunteers (control group) are examined in the research. IFN-γ, IL-4, IL-10, and total immunoglobulin E (IgE) levels from serum samples and vitamin D₃ levels from plasma were determined in all patients.

Results

In IgE, IL-4, IL-10, IFN-γ, and 1α,25-dihydroxyvitamin D₃ levels (p<0.05), a statistically noticeable difference was observed between the study and control group. The 1α,25-dihydroxyvitamin D₃ levels in both groups were compared and a statistically significant difference between the 1α,25-dihydroxyvitamin D₃ levels in the study group and that in the control group (p<0.05) was observed. There was a positive correlation between IFN-γ and vitamin D levels (p<0.05) in the study group, whereas IgE, IL-4, and IL-10 levels showed a negative correlation with vitamin D₃ levels (p<0.05).

Conclusion

In our study, 1α,25-dihydroxyvitamin D₃ levels were associated with Th1/Th2 balance in allergic rhinitis, and a remarkable correlation was observed among vitamin D deficiency and allergy. These findings show that 1α,25-dihydroxyvitamin D₃ may have a remarkable role in the severity and control of allergic disorders. In addition, further investigations are required to confirm how vitamin D should be used in allergic diseases. Furthermore, to reveal the exact mechanism of vitamin D on allergic diseases, further studies are required.

Advances in asthma drug discovery: evaluating the potential of nasal cell sampling and beyond

INTRODUCTION

Inhaled corticosteroid anti-inflammatory therapy is effective at controlling disease symptoms of asthma, but a subset of patients remains symptomatic despite optimal treatment, creating a clear unmet medical need. Moreover, none of the currently available drugs for asthma are really disease-modifying or curative. Although murine models of asthma, based on transgenic and knockout animals, may offer an integrated pathophysiological system for studying the characteristics of airway inflammation and hyperresponsiveness, these alterations are noteworthily different compared with those observed in asthmatic patients. Since a clear functional and inflammatory relationship between the nasal mucosa and bronchial tissue in patients suffering from asthma and allergic rhinitis has been recognized, using preclinical models based on human nasal cells sampling might support a prompt and effective anti-inflammatory drug discovery in asthma.

AREAS COVERED

The authors provide a review, which discusses the potential role of nasal cell sampling and its application in advanced drug discovery for asthma. The contents range from the similarities and differences between asthma and allergic rhinitis up to artificial airway models based on sophisticated human lung-on-a-chip devices.

EXPERT OPINION

Nasal cell sampling and processing have reached a great potential in asthma drug discovery. The authors believe that models of asthma, which are based on human nasal cells, can provide valuable indications of proof of pharmacological and potential therapeutic efficacy in both preclinical and early clinical settings.

IL-17 expression in dermatitis herpetiformis and bullous pemphigoid

Dermatitis herpetiformis (DH) and bullous pemphigoid (BP) are skin diseases associated with eosinophilic and neutrophilic infiltrations. Although cytokines are critical for the inflammatory process, there are single findings concerning concentration of IL-17 in bullous diseases. The goal of this study was to assess IL-17 expression in DH and BP patients. Skin biopsies were taken from 10 DH, 14 BP patients and from 10 healthy subjects. The localization and expression of IL-17 was studied by immunohistochemistry and the serum concentration was measured by immunoassays. Expression of IL-17 in the epidermis and in influxed cells in dermis was detected in skin biopsies. Expression of IL-17 was statistically higher in epidermis and infiltration cells in specimens from BP than from DH patients. Examined interleukin expression was detected in perilesional skin of all patients but it was much lower than in lesional skin. The expression of IL-17 was not observed in biopsies from healthy people. Serum level of IL-17 was statistically higher in BP and DH groups as compared to control group. Our results provide the evidence that IL-17 may play an essential role in activating and recruiting eosinophils and neutrophils, which ultimately contribute to the tissue damage in DH and BP.

The effect of academic exam stress on mucosal and cellular airway immune markers among healthy and allergic individuals

Research suggests that psychological stress can exacerbate allergies, but relatively little is known about the effect of stress on mucosal immune processes central to allergic pathophysiology. In this study, we quantified vascular endothelial growth factor (VEGF), interferon gamma (IFN-γ), and interleukin-4 concentrations in saliva (S) and exhaled breath condensate (EBC) during final exams and at midsemester among 23 healthy and 21 allergic rhinitis individuals. IFN-γs decreased during exams for both groups while VEGF(EBC) increased (and increases in VEGFs were a trend). Elevated negative affect ratings predicted higher VEGF(EBC) in allergic individuals. IFN-γ(EBC) increased in healthy individuals early during exams and then decreased, while allergic individuals showed a decrease in IFN-γ(EBC) throughout final exams. These findings suggest that psychological stress can suppress cellular immune function among allergic individuals while increasing VEGF.

The relationship between Th1/Th2 balance and 1α,25-dihydroxyvitamin D₃ in patients with nasal polyposis

We aimed to study Th1/Th2 cell balance by measuring the levels of cytokines IL-4, IL-10, and IFN-γ, which play an important role in the immune response of patients with allergic rhinitis and/or nasal polyps, and determine the correlation between Th1/Th2 cell balance and 1α,25-dihydroxyvitamin D(3), an active metabolite of vitamin D. The study subjects were 60 adult patients and 40 healthy volunteers. Subjects were separated into three groups: 30 patients diagnosed with nasal polyposis together with allergic rhinitis formed Group I, 30 patients with nasal polyposis but without allergic rhinitis constituted Group II, and 40 healthy volunteers without nasal polyp and/or allergic rhinitis were the control group, or Group III. IFN-γ, IL-4, IL-10, and total IgE levels were determined in the serum samples of all patients and vitamin D(3) in their plasma. A statistically significant difference was found between the Group I and the control group in their IgE, IL-4, IL-10, IFN-γ, and vitamin D levels (p < 0.05), while there were no such significant differences between Group II and the control group in these measurements (p > 0.05). Within Group I, vitamin D levels showed a negative correlation with IgE and IL-4 levels, and a positive correlation with IFN-γ (p < 0.05). Within Group II, IgE levels showed a positive correlation with IL-4 and IL-10 levels (p < 0.05) and a negative correlation with IFN-γ levels (p < 0.05). In this study, no significant relation was detected between vitamin D deficiency and nasal polyposis in the absence of allergic rhinitis. The study demonstrates that vitamin D is effective on Th1/Th2 balance in patients with allergic rhinitis and that there is a significant relation between vitamin D deficiency and allergy. These results are compatible with the possibility of an important role of vitamin D in the pathogenesis and degree of severity of allergic disease, and its capacity to control allergic disease.

Gene expression patterns and susceptibility to allergic responses

Allergic diseases are due to hypersensitive immune responses against otherwise innocuous allergens, and involve the dysregulated expression of numerous genes in cells from both the innate and adaptive immune systems. Allergic diseases are characterized by the enhanced production of type 2 T helper (Th2) cytokines, including interleukin-4, -5 and -13. These cytokines induce many of the pathophysiologic hallmarks of allergy, and their expression is tightly regulated at the level of gene transcription by both positively and negatively-acting transcription factors. In this review, the authors summarize data indicating that some of these factors represent checkpoints in the development of allergic diseases. Th2 gene expression is also controlled at the level of chromatin remodeling, and the implications of chromatin-based Th2 gene regulation in allergic disorders is also discussed. The differentiation of Th2 cells from naive precursors is critically dependent upon instruction received from dendritic cells, although the precise signals involved in this process are not well understood. Current thinking regarding some of the environmental cues interpreted by dendritic cells during allergen encounter, and how they promote Th2 responses will be reviewed. Understanding the cross-talk between dendritic cells and T cells holds great promise for deciphering the dysregulated immune response in allergy.

RT-PCR cytokine study in patients with allergic rhinitis

Allergic rhinitis is an inflammatory reaction of the nasal mucosa, in consequence of an IgE mediated hypersensitive reaction to inhaling allergens, involving different mediators and cytokine cells.

AIM

The purpose of this study was to evaluate the transcriptions for IL-4, IL-5, IL-8 and IFN-gama, particularly important in the nasal allergy process, especially IL-4 and IL-5. For this study we decided to evaluate atopic patients who were free from allergic crises, with the purpose of knowing the cytokine expressions during this period.

MATERIALS AND METHODS

Another prospective and transversal study was carried out, selecting 30 patients, 13 of these patients were pauci-symptomatic and 17 were non atopic. The groups were selected by means of a medical interview, an otolaryngologic clinical exam and allergy skin tests - Prick Test. The cytokines were investigated in fragments of the nasal mucosa, using RT-PCR - chosen because it has good reproducibility and specificity.

RESULTS

IL-5, IL-8, IFN-gama cytokine values were kept homogeneous in relation to the control group. Only IL-4 presented significant statistic differences.

CONCLUSION

Asymptomatic patients with allergic rhinitis presented with normalization of cytokine expression in the nasal mucosa, with exception of IL-4.

Análise de citocinas pela RT-PCR em pacientes com rinite alérgica

Rinite alérgica é uma doença que decorre de um processo inflamatório da mucosa nasal conseqüente à reação de hipersensibilidade a alérgenos inalatórios e, eventualmente, alimentares. É mediada por IgE, envolvendo diferentes células, mediadores e citocinas. OBJETIVO: Avaliar as transcrições para as seguintes citocinas: IL-4, IL-5, IL-8 e IFN-gama, particularmente importantes no processo alérgico nasal, principalmente IL-4 e IL-5. Neste estudo, optou-se por avaliar os pacientes atópicos fora das crises alérgicas, com a finalidade de se conhecer as expressões das citocinas neste período. MATERIAL E MÉTODO: Realizou-se um estudo transversal e prospectivo, selecionando-se 30 pacientes, sendo 13 pacientes portadores de rinite alérgica paucissintomáticos e 17 pacientes não-atópicos. Os grupos foram selecionados através da história, do exame clínico otorrinolaringológico e do teste alérgico cutâneo - Prick Test. O perfil das citocinas foi pesquisado nos fragmentos de mucosa nasal, através da RT-PCR semiquantitativa, escolhida por apresentar boa reprodutibilidade e especificidade, utilizando-se como referência o gene da Beta-actina. RESULTADOS: Os valores de IL-5, IL-8, IFN-gama mantiveram-se homogêneos em relação ao grupo controle. A IL-4 apresentou diferença com significância estatística. CONCLUSÃO: Os pacientes alérgicos paucissintomáticos apresentaram normalização da expressão das citocinas na mucosa nasal à exceção de IL-4.

Prevalence and associated factors of allergic rhinitis and atopic dermatitis in children

Allergic disorders are the chronic diseases of greatest pediatric morbidity, affecting over 25 % of the pediatric population. Indeed, this situation has been referred to as an "allergic epidemic". In comparison with asthma, atopic dermatitis and allergic rhinitis have been less extensively investigated, although this does not mean that they should be regarded as minor disorders but rather as alterations that affect the quality of life of the patients and their families, which generate considerable direct and indirect costs. Despite an important research effort, the reason for this allergic epidemic is not well known. These are multifactor disorders without a single causal agent, in which the most important component is the genetic predisposition of the patient (atopy), modulated by environmental factors, exposure to allergens, infections and irritants, among others. A confounding element is the fact that the concept of allergic diseases encompasses phenotypes of rhinitis, atopic dermatitis or asthma in which no IgE-mediated atopic mechanism is demonstrated, and which can manifest in a way similar to true allergic phenotypes. Differentiation between the two is difficult to establish on the basis of self-administered questionnaires alone, in the absence of a precise etiological diagnosis. The present article reviews the numerous factors suggested to be responsible for the increase in allergic diseases recorded in the last few decades, and for the differences in prevalence observed among centres. For most of these factors the results published in the literature are contradictory, in some cases due to a lack of control of the associated interacting or confounding factors. Consensus exists for only some of these causal factors, such as the established parallelism between the increase in allergic diseases and the reduction in infectious processes on one hand, and the increase in particles generated by diesel fuel combustion on the other. In addition, the implicated factors could act differently (and in some cases even antagonically) upon atopy and on the different disease phenotypes, thereby complicating the study of these interactions even further.

Effect of desloratadine on epithelial cell granulocyte-macrophage colony-stimulating factor secretion and eosinophil survival

BACKGROUND

Second-generation antihistamines are H(1) receptor antagonists and may have additional anti-inflammatory effects.

OBJECTIVE

The aims of the study were to evaluate the effect of desloratadine (DL) on cytokine secretion by epithelial cells from both nasal mucosa (NM) and polyps (NP), and on eosinophil survival primed by epithelial cell secretions.

METHODS

Epithelial cells were cultured and stimulated with fetal bovine serum (FBS), IL-1beta or TNF-alpha with and without DL for 24 h. Culture supernatant cytokines concentration were measured by ELISA. Peripheral blood eosinophils were incubated with human epithelial cell conditioned media (HECM) and DL. Eosinophil survival was assessed by Trypan blue dye exclusion. Results are expressed as mean+/-SEM of cytokine concentration (pg/mL) or eosinophil survival index (%).

RESULTS

FBS increased granulocyte-macrophage colony-stimulating factor (GM-CSF), vascular endothelial growth factor (VEGF), IL-6, IL-8, and TGF-beta(1) secretion in epithelial cell cultures from both NM and NP. Only GM-CSF secretion was significantly (P<0.05) inhibited by a dose-response of DL compared with positive controls, in both NM (10(-5) m: 125+/-36 pg/mL, 10(-6) m: 95+/-22 pg/mL vs. control: 256+/-91 pg/mL, n=6) and NP (10(-5) m: 80+/-29 pg/mL, 10(-6) m: 109+/-45 pg/mL vs. control: 333+/-212 pg/mL, n=6). DL also showed an inhibitory effect on HECM-induced eosinophil survival from both NM and NP. At 72 h, DL significantly (P<0.01) inhibited eosinophil survival induced by HECM from NM (10(-5) m: 19.9+/-5.5%, n=9; 10(-6) m: 28.7+/-7.7%, n=9) and NP (10(-5) m: 6.2+/-2.8%, n=11) compared with HECM alone (NM: 42.1+/-7.3%; NP: 45.3+/-8.1%).

CONCLUSION

The inhibitory effects of DL on epithelial cell GM-CSF secretion and on eosinophil survival induced by epithelial cell secretions, suggest that this H(1) antagonist may regulate eosinophil inflammation in upper airways.

Change in IFN-gamma-producing capacity in early life and exposure to environmental microbes

BACKGROUND

Exposure to environmental microbes in early life might lead to type 1-skewed T cell responses and therefore reduce the risk of allergic diseases.

OBJECTIVE

To investigate whether the cytokine responses at birth and at age 3 months are associated with environmental factors, especially exposure to microbes. Living in a farm, level of house dust endotoxin, cleanliness of the home, and presence of cats and dogs in the household were studied as possible determinants of cytokine production.

METHODS

Twelve farmers' and 17 nonfarmers' children were studied. Production of IL-4, IL-6, TNF-alpha, and IFN-gamma in cord blood and in peripheral blood at 3 months was measured after 8-hour and 24-hour stimulation with phorbol ester plus concanavalin A.

RESULTS

IFN-gamma responses at age 3 months were associated with farming (median, 53 vs 17 pg/mL; P = .019) and cats and dogs (49 vs 14 pg/mL; P = .014) (8 hours). Change in IFN-gamma-producing capacity from birth to 3 months was larger in children with higher than median endotoxin concentration in bed dust (P = .038) and in children with a cat or dog (P = .005) (8 hours). Increased IL-6 responses at birth were associated with cat or dog exposure (P = .004; 8 hours) and endotoxin level in settled dust (P = .039; 24 hours).

CONCLUSION

The development of IFN-gamma-producing capacity during the first 3 months of life is associated with farming, endotoxin in house dust, and cat and dog exposure. These environmental characteristics may indicate some microbial exposure capable of driving developing immune system toward T(H)1 responses.

Cytokine secretion in nasal mucus of normal subjects and patients with allergic rhinitis

Allergic rhinitis is regulated by the local production and release of several cytokines. The levels of Th2 cytokines IL-4, IL-6, IL-10 and the Th1 cytokine IFN-gamma were studied in nasal mucus from 30 subjects with allergic rhinitis and 45 non-atopic healthy controls. In this study a sampling technique for collecting nasal mucus, well tolerated by the subjects and with a minimal stimulation of the mucosa, was performed. The cytokine concentrations in nasal mucus samples were detected and quantitated by a new paramagnetic particle-based immunofluorescent assay system more sensitive than the conventional ELISA techniques. The new technique showed reliable values of the measured parameters. The nasal mucus from allergic patients contained significantly higher concentrations of IL-4 (25.5 +/- 3.6 pg/ml; P < 0.001) and IL-10 (1300 +/- 190 pg/ml; P < 0.05) compared to the nasal mucus from control subjects (15.2 +/- 2.3 and 532 +/- 28 pg/ml, respectively, for IL-4 and IL-10). No significant modification in IFN-gamma levels of allergic patients was found when compared to control group (respectively, 19.9 +/- 3.3 vs. 25.7 +/- 5.1 pg/ml; P > 0.05). Moreover, the allergic patients showed lower levels of IL-6 concentrations in the nasal mucus compared to control subjects (64.8 +/- 9.1 vs. 129.0 +/- 18.1 pg/ml; P = 0.0099). These data can be interpreted by the hypothesis that in response to environmental allergens there is a preferential Th2 polarity by activated CD4+ T cells and that the cytokines IL-6 and IL-10 have, respectively, an important anti-inflammatory and counterregulatory action in the pathogenesis of allergic rhinitis.

Immune modulation with a staphylococcal preparation in fibromyalgia/chronic fatigue syndrome: relation between antibody levels and clinical improvement

The aims of this study were to evaluate the serological response to treatment with staphylococcal vaccine in fibromyalgia/chronic fatigue syndrome patients and to explore the relationship between serological response and clinical effect. Twenty-eight patients, half of whom served as controls, were recruited from a 6-month randomised trial in which repeated administration of the staphylococcal toxoid vaccine Staphypan Berna (Berna Biotech, Switzerland) was tested against placebo. Antibody status against extracellular toxins/enzymes, cell-wall components, and enterotoxins was evaluated at baseline and at endpoint. The clinical response to treatment was recorded in rating scales. In the group receiving active treatment, significant serological changes were recorded, whereas no significant changes were found in controls. Treatment led to a significantly increased capacity of serum to neutralise alpha-toxin and a significant increase in serum IgG to alpha-toxin and lipase. Furthermore, the increase in these parameters combined paralleled the improvement in clinical outcome. Thus, the greater the serological response, the greater was the clinical effect. In conclusion, this explorative study has shown that repeated administration of the Staphypan Berna vaccine in patients with fibromyalgia/chronic fatigue syndrome causes a serological response to several staphylococcal antigens, particularly to certain extracellular toxins and enzymes. The results further show that this response is related to the clinical outcome of treatment.

Steroid-sensitive indices of airway inflammation in children with seasonal allergic rhinitis

Previous studies involving adults have demonstrated that airway glucocorticosteroids inhibit plasma exudation and eosinophil activity in allergic rhinitis. This study explores the possibility that plasma exudation, exudative responsiveness, and the occurrence of eosinophil activity-related proteins are glucocorticosteroid-sensitive nasal mucosal indices in allergic children. Using a placebo-controlled, parallel-group design effects of nasal budesonide (64 microg per nasal cavity b.i.d) were determined in children with seasonal allergic rhinitis. Nasal lavage fluid levels of eotaxin, eosinophil cationic protein (ECP), and alpha2-macroglobulin, indicating plasma exudation, were determined, the latter with and without challenge with topical histamine. Nasal lavage fluid levels of alpha2-macroglobulin and ECP increased significantly during the pollen season, and the acute plasma exudation response to histamine was significantly greater during than outside the season. There was a trend towards a seasonal increase in nasal lavage fluid levels of eotaxin. Budesonide significantly inhibited the seasonal increase in alpha2-macroglobulin as well as the exudative hyperresponsiveness to histamine. Any tendency of increases in mucosal output of eotaxin and ECP was abolished by the glucocorticosteroid treatment. We conclude that mucosal exudation of plasma, as a global sign of active inflammatory processes, is a glucocorticosteroid-sensitive facet of allergic rhinitis in children. Exudative hyperresponsiveness, potentially caused by several weeks of mucosal inflammation, emerges as a significant feature of allergic rhinitis in children, and its development is prevented by local treatment with a glucocorticosteroid drug. The seasonal increase in ECP and the trend for an increase in eotaxin were absent in the glucocorticosteroid-treated subjects.

Treatment of allergic rhinitis

Allergic rhinitis, a common and often debilitating disease marked by rhinorrhea, nasal congestion, nasal itching, and sneezing, is on the increase worldwide. Treatment involves allergen avoidance, pharmacotherapy, and, in selected cases, immunotherapy. This overview describes the characteristics, pathogenesis, and diagnosis of allergic rhinitis. The major contributing allergens of seasonal and perennial allergic rhinitis are identified. Pharmacotherapy is described within the context of treatment guidelines developed by the major asthma and allergy professional organizations. Oral H1 antihistamines are first-line therapy for mild-to-moderate allergic rhinitis. The newer, nonsedating agents are recommended over first-generation antihistamines. Some of the newer oral antihistamines, such as cetirizine, desloratadine, and fexofenadine, have been shown to relieve the symptom of nasal congestion. Intranasal steroids are first-line therapy for patients with more severe symptoms.

Inflammatory mediators in blood and urine

Inflammation plays a major role in the pathophysiology of asthma. Therefore, monitoring of the disease and its management preferably should include assessment of mediators of airways inflammation. Much interest has been focused on using eosinophil granule proteins in blood and urine as markers of asthma inflammation. The eosinophil granule proteins are important mediators in allergic inflammation. They often function well as inflammatory markers when used in controlled clinical studies, and are therefore useful research tools. With urinary eosinophil-derived protein X (EPX) venous blood sampling is avoided. Disadvantages which limit usefulness in clinical practice are overlap between values in patients and controls, a rather weak correlation to traditional lung function variables, elevation of levels by concurrent allergic disease, and the delay between sampling and test results. Urinary excretion of leukotriene E4 (LTE(4)) reflects the production of cysteinyl leukotrienes, which are major mediators in asthma. The excretion of LTE4 possibly reflects lung function better than serum ECP. In the future, monitoring of cytokines may be used in clinical asthma to monitor control and aid in the prognosis of the disease in the young child. Techniques for simple and rapid monitoring of key type 1 and type 2 cytokines are needed.

Topical steroid treatment of allergic rhinitis decreases nasal fluid TH2 cytokines, eosinophils, eosinophil cationic protein, and IgE but has no significant effect on IFN-gamma, IL-1beta, TNF-alpha, or neutrophils

BACKGROUND

Topical treatment with glucocorticoids (GCs) is known to decrease eosinophils but not neutrophils in patients with allergic rhinitis.

OBJECTIVE

We sought to examine whether the differential effects of GC treatment on eosinophils and neutrophils are mirrored by differential effects on T(H)1/T(H)2 cytokines and the neutrophil-associated cytokines IL-1beta and TNF-alpha.

METHODS

Differential counts of eosinophils and neutrophils in nasal fluids from 60 children with seasonal allergic rhinitis treated with a topical GC were examined after staining with May-Grünwald-Giemsa stain. Nasal fluid levels of IFN-gamma, IL-4, IL-6, IL-10, IL-1beta, and TNF-alpha were examined with ELISA, and IgE and eosinophil cationic protein (ECP) levels were examined with RIA.

RESULTS

After GC treatment, there was a statistically significant decrease of the T(H)2 cytokines IL-4, IL-6, and IL-10, as well as ECP and IgE. By contrast, there were no significant changes of the levels of IFN-gamma, IL-1beta, TNF-alpha, or neutrophils. In the GC-treated patients IL-1beta and TNF-alpha levels correlated with neutrophils and ECP, and IL-1beta correlated with eosinophils. Furthermore, ECP correlated with both eosinophils and neutrophils. Neither IL-1beta nor TNF-alpha correlated with IgE. Patients with high neutrophil counts after GC treatment were found to have significantly higher eosinophil counts and ECP than patients with low counts.

CONCLUSIONS

The beneficial effects of topical treatment with GC in patients with allergic rhinitis could be attributed to downregulation of T(H)2 cytokines, with an ensuing decrease of eosinophils, ECP, and IgE. It is possible that neutrophils could counteract the beneficial effects of GCs by releasing the proinflammatory cytokines IL-1beta and TNF-alpha.