ICAM-1 expression in upper respiratory mucosa is differentially related to eosinophil and neutrophil inflammation according to the allergic status

Quail egg homogenate with zinc as adjunctive therapy in seasonal allergic rhinitis: a randomised, controlled trial

OBJECTIVE

Because most available treatments for managing seasonal allergic rhinitis show some side effects without reducing recurrence, natural anti-allergic products could represent an interesting treatment addition. This study aimed to analyse the efficacy and tolerance of quail egg as adjunctive therapy in seasonal allergic rhinitis.

METHOD

In a Consolidated Standards of Reporting Trials compliant framework, patients with seasonal allergic rhinitis were prospectively randomised to receive mometasone nasal spray for four weeks or the same topical corticosteroid therapy plus commercially available oral quail egg and zinc tablets.

RESULTS

Forty patients were enrolled. The mometasone + quail egg and zinc tablets group showed a greater reduction in nasal itching, sneezing and total nasal symptom scores than the mometasone nasal spray only group. A higher proportion of participants in the mometasone + quail egg and zinc tablets group had good rhinitis control than in the mometasone nasal spray only group, with no need for rescue medications.

CONCLUSION

Despite the need for a further larger study, quail egg preliminarily appears to be an effective adjunct to topical steroid therapy in seasonal allergic rhinitis.

Efficacy of a Quail Eggs-Based Dietary Supplement for Allergic Rhinitis: Results of a Single-Arm Trial

Previous data suggested the potential treatment effect of a proprietary quail eggs-based blend on allergic rhinitis (AR) symptoms, induced by allergen challenge. We herein aimed to investigate the efficacy and safety of a similar dietary supplement, comprising the bioactive ingredients of quail eggs and the zinc mineral, in the setting of active AR. Adult patients (n = 77), aged 18- 60 years, with mild, intermittent AR were enrolled in this single-arm, open-label trial. Patients' responses were assessed based on peak nasal inspiratory flow (PNIF) measurements at two visits (Day 1/Visit 1 and Day 7/Visit 2) and self-rating of AR-associated symptoms on a Visual Analog Scale (VAS) throughout the entire 7-day study period. PNIF values at 15, 30, 60, 90 and 120 min (Visit 1) following administration of an oral dose of the study product were the primary efficacy endpoint. PNIF values (Visit 1) gradually increased from baseline (pre-treatment), with statistical significance first reached 30 min later (p = 0.002). VAS scores (Visit 1) for all AR symptoms gradually decreased with statistical significance first reached at 15 min (rhinorrhea, p = 0.042; itchy nose, p = 0.001; sneezing p < 0.001), 30 min (nasal congestion, p < 0.001; itchy eyes, p = 0.003) or 60 min (watery eyes, p = 0.04). PNIF improvement and decline of VAS scores were significantly more apparent at Visit one vs. Visit 2. Treatment-emergent adverse events were limited to cough and muscle strain (one patient each). Our results support the efficacy, rapid mode of action and tolerability of the investigated product for symptomatic treatment of mild intermittent AR.

No Differences in Nasal Tissue Inflammatory Cells and Adhesion Molecules (iCAM-1 and vCAM-1) Based on the Comparison of EGPA With Eosinophilic Chronic Sinusitis With Polyposis

Background

An example of aggressive eosinophilic polyposis can be found in eosinophilic granulomatosis with polyangiitis (EGPA). Intercellular adhesion molecule-1 (iCAM-1) and vascular cell adhesion molecule-1 (vCAM-1) play a part in mediating the recruitment and adhesion of leukocytes to the vessel wall, and their blood-to-tissue migration under inflammatory conditions.

Objective

This prospective study compared 3 groups—patients with a definite diagnosis EGPA, non-EGPA patients with phenotypic features suggestive of EGPA, and patients with non-eosinophilic nasal polyposis (controls)—in terms of nasal tissue histology, iCAM-1 and vCAM-1 expression, and blood inflammatory cells.

Methods

A total of 58 adults underwent sinus surgery (13 patients with EGPA, 23 suspected of having EGPA, and 22 controls).

Results

Mean tissue eosinophil counts were significantly higher in EGPA patients and suspected cases of EGPA than in controls. Although iCAM-1 and vCAM-1 were diffusely expressed in sinonasal tissues, they did not differently stain EGPA, eosinophilic-type and non-eosinophilic polyposis. Blood basophil and eosinophil levels were high in both the EGPA and the suspected EGPA groups. Intergroup differences were found for eosinophils but not for basophils.

Conclusions

We do not have yet blood or tissue markers able to differentiate the early phase of EGPA from chronic rhinosinusitis with nasal polyps. Further investigations are mandatory considering EGPA patients at their initial diagnosis and before any treatment, in terms of nasal histology and blood inflammatory cells, to identify markers characterizing sinonasal mucosa inflammation and useful for an early diagnosis of EGPA.

Biochemical and physiological effects from exhaust emissions. A review of the relevant literature

Exhaust emissions are to date ranked among the most frequent causes of premature deaths worldwide. The combustion of fuels such as diesel, gasoline, and bio-blends provokes a series of pathophysiological responses in exposed subjects, which are associated with biochemical and immunological triggering. It is critical to understand these mechanisms, which are directly related to the levels of aerosol, liquid and gaseous components in fuel exhaust (e.g. nanoparticles, particulate matter, volatile compounds), so to cast attention on their toxicity and gradually minimize their use. This review reports findings in the recent literature concerning the biochemical and cellular pathways triggered during intoxication by exhaust emissions, and links these findings to pathophysiological responses such as inflammation and vasoconstriction. This study provides critical in vitro and in vivo data for the reduction of emissions in urban centers, with an emphasis on the prevention of exposure of groups such as children, the elderly, and other affected groups, and shows how the exposure to exhaust emissions induces mechanisms of pathogenesis related to cardiopulmonary pathologies and long-term diseases such as asthma, allergies, and cancer. This review summarizes the cellular and physiological responses of humans to exhaust emissions in a comprehensive fashion, and is important for legislative developments in fuel politics.

Differential expression of adhesion molecules by sinonasal fibroblasts among control and chronic rhinosinusitis patients

BACKGROUND

Chronic rhinosinusitis (CRS) is characterized by inflammatory cell migration into sinus tissue with resultant inflammation fueled by a milieu of cytokines. Fibroblasts may contribute to inflammation through expression of leukocyte adhesion molecules such as vascular cell adhesion molecule (VCAM) and intercellular adhesion molecule (ICAM). VCAM attracts eosinophils and mast cells contributing to Th2 skewing, and ICAM attracts neutrophils and to a lesser degree, eosinophils, and contributes to mixed Th1/Th2 skewing. The purpose of this study was to compare sinus fibroblast adhesion molecule expression ex vivo among CRS subtypes and in vitro after cytokine stimulation.

METHODS

Sinus biopsy specimens were taken from control patients (n = 13), CRS without nasal polyposis (CRSsNP, n = 6), and CRS with nasal polyposis (CRSwNP, n = 15). ex vivo levels of VCAM and ICAM were measured by flow cytometry from single cell suspensions of tissue biopsy specimens. Changes in VCAM and ICAM expression to cytokine exposure were assessed using in vitro cultured sinonasal fibroblasts treated with tumor necrosis factor (TNF)-α, interleukin (IL)-4, or interferon (IFN)-γ.

RESULTS

ex vivo VCAM expression was lowest in controls, higher in CRSsNP, and highest in CRSwNP. in vitro stimulation with TNF-α and IL-4, but not IFN-γ, increased VCAM among CRSsNP, while expression in CRSwNP remained elevated with all treatments except IFN-γ. ex vivo ICAM expression was elevated in both CRS subtypes. in vitro stimulation with TNF-α and IFN-γ, but not IL-4, increased ICAM expression in all patients with the largest effects among the CRSsNP subgroup.

CONCLUSION

Sinonasal fibroblast expression of adhesion molecules in sinusitis varies by disease state and is selectively influenced by exposure to inflammatory cytokines.

Lactate dehydrogenase-elevating virus infection at the sensitization and challenge phases reduces the development of delayed eosinophilic allergic rhinitis in BALB/c mice

The present study was conducted to determine whether lactate dehydrogenase-elevating virus (LDV) infection at the sensitization and challenge phases affect the development of delayed allergic eosinophilic rhinitis induced by ovalbumin (OVA) in BALB/c mice (DAR group). Compared to the DAR group, LDV infection at the priming (DAR/LDVs group) and immunizing (DAR/LDVc group) phases reduced the induction of eosinophils in the bone marrow (BM) and/or blood. However, the number of eosinophils in the BM was not affected in the DAR/LDVc group. In addition, total blood IgE values were reduced in the DAR/LDVs but not the DAR/LDVc groups. Compared to the production of cytokines from splenic cells and blood IgE values in the DAR group, OVA-specific IL-4 and IFN-gamma productions and IgE values were reduced in the DAR/LDVs, whereas OVA-specific IFN-gamma and IL-4 productions were increased and decreased, respectively in the DAR/LDVc,but not the DAR/LDVs groups. Both DAR/LDVs and DAR/LDVc groups reduced the development of eosinophilic rhinitis associated with reduced VCAM-1 expression on endothelium in blood vessels and ICAM-1 expression on nasal respiratory epithelium at inflamed areas. The present study suggests that LDV infection at the sensitization phase may reduce the development of T helper (Th) 1 and Th2 responses, whereas LDV infection at the challenge phase may inhibit the development of Th2 response by shifting to Th1 response. These may be responsible for the reduction of the development of DAR by LDV infection.

Adhesion molecules and their ligands in nasal polyps of aspirin-hypersensitive patients

BACKGROUND

Chronic inflammation with tissue eosinophilia plays a key role in the pathogenesis of asthma and nasal polyps in patients with aspirin hypersensitivity.

OBJECTIVE

To evaluate the expression of vascular cell adhesion molecule 1 (VCAM-1) and intercellular adhesion molecule I (ICAM-1) and their ligands (the integrins lymphocyte function-associated antigen 1 and very late-activation antigen 4 [VLA-4]) in nasal polyps of patients with aspirin hypersensitivity compared with aspirin-tolerant individuals.

METHODS

Immunohistochemical studies were performed using a peroxidase method and monoclonal antibodies on 6-microm-thick cryostat sections cut from frozen polyps collected during elective surgery from 21 aspirin-sensitive and 23 aspirin-tolerant patients.

RESULTS

The mean +/- SD values of the semiquantitatively evaluated immunoexpression of ICAM-1, VCAM-1, and VLA-4 were significantly increased in patients with aspirin hypersensitivity compared with aspirin-tolerant patients (1.7 +/- 0.8 vs 0.9 +/- 0.8, P < .003; 1.8 +/- 0.8 vs 0.8 +/- 0.8, P < .001; and 2.2 +/- 0.7 vs 1.3 +/- 0.7, P < .001, respectively), whereas the mean +/- SD values of the expression of lymphocyte function-associated antigen 1 did not differ significantly (2.4 +/- 0.5 vs 2.2 +/- 0.9; P = .57). We found a correlation between the immunoexpression of VCAM-1 and its ligand VLA-4 in all studied tissue samples (r = 0.4; P < .02).

CONCLUSIONS

In nasal polyps of aspirin-hypersensitive patients, up-regulation of the adhesion molecules ICAM-1 and VCAM-1 and the integrin VLA-4 may play an important role in the development of chronic eosinophilic inflammation.

Allergic rhinitis in children : diagnosis and management strategies

The incidence of allergic rhinitis has been increasing for the last few decades, in keeping with the rising incidence of atopy worldwide. Allergic rhinitis has a prevalence of up to 40% in children, although it frequently goes unrecognized and untreated. This can have enormous negative consequences, particularly in children, since it is associated with numerous complications and comorbidities that have a significant health impact on quality of life. In fact, allergic rhinitis is considered to be a risk factor for asthma. There are numerous signs of allergic rhinitis, particularly in children, that can alert an observant clinician to its presence. Children with severe allergic rhinitis often have facial manifestations of itching and obstructed breathing, including a gaping mouth, chapped lips, evidence of sleep deprivation, a long face, dental malloclusions, and the allergic shiner, allergic salute, or allergic crease. The medical history is extremely important as it can reveal information regarding a family history of atopy and the progression of atopy in the child. It is also important to identify the specific triggers of allergic rhinitis, because one of the keys to successful management is the avoidance of triggers. A tripartite treatment strategy that embraces environmental control, immunotherapy, and pharmacologic treatment is the most comprehensive approach. Immunotherapy has come to be viewed as potentially prophylactic, capable of altering the course of allergic rhinitis. The most recent guidelines for the management of allergic rhinitis issued by the WHO recommend a tiered approach that integrates diagnosis and treatment, in which allergic rhinitis is subclassified both by frequency, as either intermittent or persistent, and by severity, as either mild or moderate to severe. Oral or topical antihistamines and intranasal corticosteroids are the mainstay of pharmacologic therapy for allergic rhinitis, depending upon its severity, and several agents have been approved for use in children aged 5 years old and younger.

Zinc metabolism in airway epithelium and airway inflammation: basic mechanisms and clinical targets. A review

In addition to basic housekeeping roles in metalloenzymes and transcription factors, dietary zinc (Zn) is an important immunoregulatory agent, growth cofactor, and cytoprotectant with anti-oxidant, anti-apoptotic, and anti-inflammatory roles. These properties of Zn are of particular importance in maintaining homeostasis of epithelial tissues which are at the front line of defense. This review is about the role of Zn in airway epithelium (AE). The first part focuses on the cellular biology of Zn, and what is known about its distribution and function in AE. The second part of the review considers evidence for altered Zn metabolism in asthma and other chronic diseases of airway inflammation. Important issues arise from a potential therapeutic perspective as to the optimal ways to monitor circulating and epithelial Zn levels in patients and the most effective means of supplementing these levels.

Intercellular adhesion molecule-1 expression in nasal polyps treated with corticosteroid

PURPOSE

The aim of this study was to compare intracellular adhesion molecule-1 (ICAM-1) expression in nasal polyp cases who were administered topical corticosteroid and in middle turbinates.

MATERIALS AND METHODS

Twenty-four patients with nasal polyps were included in the study group. These patients were treated with 100 microg budesonide in each nostril twice daily for 2 months before the surgery. Twenty-one nonatopic patients with concha bullosa were included in the control group. The specimens were taken from patients undergoing endoscopic surgery.

RESULTS

In polyps, significantly higher mean ICAM-1 intensity scores were found by comparison with the control turbinates.

CONCLUSIONS

Corticosteroid treatment in patients with nasal polyps does not diminish ICAM-1 to that of turbinate tissue. The initiating events in the formation of nasal polyps still occur in these patients despite treatment with the topical nasal steroid.

Effect of glucocorticosteroids on tumour necrosis factor-alpha-induced intercellular adhesion molecule-1 expression in cultured primary human nasal epithelial cells

OBJECTIVE

In order to confirm the direct effect of glucocorticosteroids on epithelial intercellular adhesion molecule-1 (ICAM-1) expression, we examined ICAM-1 expression on primary cultured human nasal epithelial cells (HNECs) at both protein and mRNA levels.

MATERIAL AND METHODS

HNECs were stimulated with recombinant human TNF-alpha (20 pg/mL-20 ng/mL) for specified time periods (0, 12, 24, and 48 h) and ICAM-1 mRNA and the soluble ICAM-1 (sICAM-1) concentrations were measured by quantitative RT-PCR and ELISA, respectively. We also evaluated surface expression of ICAM-1 by flow cytometry 48 h after stimulation and determined the effect of dexamethasone (DEX) on TNF-alpha-induced ICAM-1 expression.

RESULTS

Significant increases in ICAM-1 gene expression in HNECs were initially detected at 24 h, peaking at 48 h after the stimulation. The TNF-mediated-ICAM-1 mRNA and ICAM-1 surface expression at 48 h was significantly inhibited by co-incubation with human recombinant soluble TNF receptor I. Similarly, TNF-alpha-induced release sICAM-1 occurred in a time- and concentration-dependent manner. DEX 10(-6) M attenuated the TNF-alpha-induced ICAM-1 expression at mRNA and protein levels.

CONCLUSIONS

Our finding suggests a potential role for topical steroids in allergic rhinitis in suppressing inflammatory reactions in the nasal mucosa by regulating ICAM-1 expression on nasal epithelium.

Expression of intercellular adhesion molecules on circulating lymphocytes in relation to different manifestations of cow's milk allergy

BACKGROUND

The complex interactions between immune cells are partly mediated by different adhesion molecules, but little is known about their role in the systemic immunoinflammatory process following sensitization to food antigens in early infancy.

OBJECTIVE

The aim of this study was to investigate the expression of intercellular adhesion molecule-1 (ICAM-1or CD54) and the alpha subunits of its ligands' lymphocyte function-associated antigen-1 (LFA-1) (alphaL subunit or CD11a) and Mac-1 (alphaM subunit or CD11b) on peripheral blood leucocytes in infants with cow's milk allergy (CMA) and in healthy controls.

METHODS

Thirty-nine breastfed infants, aged from 0.6 to 8.3 months, and their lactating mothers were included in the study from delivery onwards. During follow-up, 25 infants developed CMA and 14 remained healthy. Expressions of CD54 and CD11b on peripheral blood leucocytes were evaluated by flow cytometry. In addition, the expression of CD11a on peripheral blood leucocytes was analysed by immunocytochemistry. Mothers' milk samples were collected and their leucocyte content was evaluated using a light microscope.

RESULTS

The frequency of ICAM-1 expressing peripheral blood lymphocytes was significantly higher in patients with CMA than in healthy infants (P=0.03, Mann-Whitney U-test). Furthermore, the high proportion of ICAM-1-expressing cells was associated with gastrointestinal and multiorgan symptoms in the CMA infants. There was no significant difference in the expression of Mac-1 alphaM on lymphocytes in our study groups, but the LFA-1 alphaL expression seemed to be higher in the IgE-mediated CMA.

CONCLUSION

We suggest that the high expression of ICAM-1 on peripheral blood lymphocytes may reflect enhanced stimulation of T cells in vivo and their migration to the effector tissues in an early-phase of developing CMA. Furthermore, high ICAM-1 expression may be associated with the presence of multiorgan manifestations of CMA, whereas high LFA-1 expression may reflect the IgE-mediated disease.

HLA-DR and ICAM-1 expression and modulation in epithelial cells from nasal polyps

OBJECTIVE/HYPOTHESIS

Through human leukocyte antigen-DR (HLA-DR) and intercellular adhesion molecule-1 (ICAM-1) expression, nasal epithelial cells could actively participate in the chronic inflammation and eosinophil infiltration observed in nasal polyps. The objective of the study was to evaluate HLA-DR and ICAM-1 expression in polyp epithelium and in a culture model of polyp epithelial cells allowing ciliated and secretory differentiation.

STUDY DESIGN

Prospective non-randomized controlled in vitro study.

METHODS

The in vitro HLA-DR and ICAM-1 expression was studied under basal conditions or after exposure to interferon-gamma, transforming growth factor-beta1, lipopolysaccharide, dexamethasone, or cetirizine. HLA-DR and ICAM-1 expression was investigated in situ by immunohistochemical staining of polyps and in vitro by immunofluorescent staining of cell cultures. HLA-DR and ICAM-1 were localized in cultured cells by confocal microscopy. Cultured cells expressing HLA-DR and ICAM-1 were quantified by flow cytometry.

RESULTS

Both HLA-DR and ICAM-1 showed significant immunostaining of nasal polyp epithelium. In nasal polyp epithelial cell cultures, less than 5% of cells were positive for HLA-DR whereas 40% were positive for ICAM-1 at day 3. In vitro, HLA-DR was mainly located in the cytoplasm and ICAM-1 predominated on the apicolateral cytoplasmic membrane. Comparison of in situ and in vitro results showed that well-differentiated and poorly differentiated cells predominantly expressed HLA-DR and ICAM-1, respectively. Interferon-gamma significantly increased HLA-DR and ICAM-1 expression, whereas transforming growth factor-beta1 significantly decreased HLA-DR expression and lipopolysaccharide significantly increased ICAM-1 expression.

CONCLUSION

HLA-DR and ICAM-1 epithelial expression in nasal polyps in situ and in vitro and their in vitro modulation reinforce the active role of epithelial cells in chronic inflammatory diseases of the upper airways.

The stimulatory effects of nasal discharge from patients with perennial allergic rhinitis on normal human neutrophils are normalized after treatment with a new mixed formula of Chinese herbs

In our previous study, we found a new mixed formula of Chinese herbs containing Shin-yi-san + Xiao-qing-long-tang + Xiang-sha-liu-jun-zi-tang (9 + 3 + 3 g divided in three doses/day) was beneficial to the patients with perennial allergic rhinitis (AR) via complicated immunomodulatory effects on both mononuclear cells (MNC) and polymorphonuclear neutrophils (PMN). In the present study, we further determined the effects of nasal fluid from AR patients on the functions of human PMN before and after treatment with the mixed formula. We found the nasal discharge, but not serum, from AR group with high serum IgE (H-IgE, serum IgE >200 KIU/l) before treatment exerted many stimulating effects on normal PMN including delayed apoptosis, enhanced production of soluble intercellular adhesion molecule 1 (sICAM-1), interleukin 8 (IL-8) and prostaglandin E2 (PGE2), increased phagocytosis, and augmented cyclooxygenase 2 (COX-2) mRNA expression of PMN. However, these stimulating effects of nasal fluid on PMN were not found in low IgE group (L-IgE, serum IgE <200 KIU/l). These PMN-enhancing effects of H-IgE nasal fluid were abolished after 3-month treatment with the mixed Chinese herb formula. In conclusion, our results suggest that the new mixed herb formula treatment suppressed nasal mucosa inflammation by normalizing stimulatory effects of allergic nasal discharge of patients with H-IgE allergic rhinitis.

Non-allergic rhinitis: diagnosis and management

Patients in the rhinitis clinic with negative skin prick tests present a challenge. Non-allergic rhinitis consists of a variety of conditions including infection, hormonal changes, drugs and autonomic dysfunction. There is also a range of systemic disorders to be considered. The pathogeneses of many of these are less well understood than that of allergic rhinitis, diagnosis and treatment pathways are also more complex. A detailed accurate history needs to be taken followed by relevant investigations which may include allergen challenge, because skin prick and RAST-negative allergic rhinitis is now recognised. Nitric oxide levels may prove helpful: elevated levels suggest inflammation, very low levels indicate the possibility of primary ciliary dyskinesia or cystic fibrosis. Treatment is of the underlying cause when found: for those without obvious pathology a trial of combined therapy with topical corticosteroids plus antihistamine or plus anti-cholinergic may be worth while. A complex inter-relationship between allergic and infectious rhinitis is becoming apparent.

Expression of intercellular adhesion molecule-1 (ICAM-1) in nasal epithelial cells of atopic subjects: a mechanism for increased rhinovirus infection?

Since clinical experimental studies indicate that upper respiratory tract viral infections may exacerbate acute asthma symptoms in atopic/asthmatic individuals, we have investigated the expression and modulation of ICAM-1 on human nasal epithelial cells (HNEC) from normal and atopic subjects. ICAM-1 is the attachment molecule for the majority of serotypes of human rhinovirus (HRV), including HRV-14, and is also critical for the migration and activation of immune effector cells. Basal ICAM-1 expression was significantly higher in HNEC obtained by brushings from atopic compared with non-atopic subjects (P = 0.031), and was also significantly increased on atopic HNEC harvested in season compared with out of season (P < 0.05). Atopic HNEC showed further up-regulation in ICAM-1 expression when cultured with clinically relevant allergen (P = 0.032). ICAM-1 levels on normal HNEC were also increased by infection with HRV-14 (P < 0.05). Basal expression of ICAM-1 on atopic nasal polyp epithelial cells (EC) was significantly higher than on both normal and atopic nasal HNEC. This elevated nasal polyp ICAM-1 level was not increased further by allergen, although HRV infection resulted in a small significant increase. Recovered viral titres from HRV-infected nasal polyp EC were 1.5-fold higher than from infected normal nasal HNEC. The data are consistent with the hypothesis that allergen, by enhancing expression of the HRV attachment target on host cells, facilitates viral infection in atopic subjects; simultaneously HRV-induced increases in ICAM-1 levels would favour migration and activation of immune effector cells to the airway, resulting in enhanced atopic inflammation.

Nasal lavage mediator profile and cellular composition of nasal brushing material during latex challenge tests

BACKGROUND

Recent studies have shown that airborne latex allergens cause allergic rhinitis and bronchial asthma.

OBJECTIVE

The aim of this study was to investigate the association between the development of rhinitis reactions during workplace-related inhalative challenge tests and nasal allergic inflammation.

METHODS

Thirty-two health care workers (HCWs) with suspected respiratory hypersensitivity to latex allergens underwent an inhalative workplace-related challenge test with powdered latex gloves. Nasal lavage fluid (NALF) and nasal brushing (NAB) material were collected before and after exposure (30 min, 2, 6 and 24 h) to determine mediator and cellular composition. In addition, lung function parameters and nasal flow were recorded. Furthermore, six healthy controls underwent nasal brushing and nasal lavage without latex allergen challenge at the same time intervals.

RESULTS

Twenty-six HCWs showed acute rhinitis by contact to airborne latex allergen exposure and 10 of them had an additional asthma response. Only in responders, significantly increased eosinophil levels were found 6 h (P < 0.00001) and 24 h (P < 0.0005) post-challenge when compared with the prechallenge values. The ECP levels measured 2, 6 and 24 h post-challenge in the responder group were significantly elevated when compared with the prechallenge values as well as with the non-responders (6 h: P < 0.05, 24 h: P < 0.00001 afterwards). Only in some concentrated NALF samples of responders collected 30 min post-challenge (seven out of 15) tryptase concentration above the detection limit were found. The NO derivative concentrations in NALF were significantly increased 6 h post-challenge compared with the prechallenge values (P < 0.05) and were significantly higher in responders than in non-responders and in controls (P < 0.002). IL-5 levels increased post-challenge in the responder group with a pronounced effect 6 h after challenge (P < 0.001). Overall, a variety of parameters was significantly correlated (e.g. ECP with NO derivatives, r = 0.792 P < 0.002).

CONCLUSIONS

Our data demonstrate for the first time that nasal and bronchial hyperreactivity to airborne latex allergens are associated with an increase of eosinophils and mediators (e.g. ECP, NO derivatives, IL-5, tryptase) in nasal mucosa. The combined use of NAB (for cells) and NALF (for mediators) appears to be a useful model to monitor nasal inflammation during workplace-related challenge tests.