Increased ciliary beating frequency of nasal mucosa following immunotherapy for allergy

Nasal Ciliary Beat Frequency after Nasal Allergen Challenge

The aim of this study was to estimate nasal ciliary beat frequency (CBF) before and after nasal allergen challenge. Patients were challenged with Pharmalgen D Pteronyssinus or grass pollen. The nasal reaction was measured with active anterior rhinomanometry and visual analog scale. CBF was measured by a photometric technique, on nasal specimens obtained with a brush from the inferior turbinate before and 20 minutes after challenge. A positive response to nasal challenge was seen in 12 patients and associated with a decrease in CBF in all but one patient. The CBF mean value for this group fell from 13.1 (±1.9) Hz to 11.5 (±1.8) Hz (p < .01). In another 11 patients where the challenge was negative, there was a tendency to increased CBF after challenge, 14.1 (±2.1) Hz before and 14.8 (±2.1) Hz after (p = .07). Thus, in this study CBF was decreased when an allergic reaction was provoked and, in contrast, moderately increased after a negative challenge. In a nasal allergic reaction it is possible that decreased mucociliary function contributes to nasal obstruction and decreased ventilation of the sinuses.

The effect of injection immunotherapy on mucociliary clearance in allergic patients

OBJECTIVE

To assess the effect of injection immunotherapy on mucociliary clearance in allergic patients with the use of the saccharin test.

METHODS

In this prospective cohort study, mucociliary clearance in 42 allergic patients treated with injection immunotherapy was determined with the saccharin test. Of these patients, 23 were retested 1 year later to assess changes in mucociliary clearance times. Mean results for historical controls were determined in a review and meta-analysis of the existing literature.

RESULTS

Saccharin clearance times (SCTs) were initially prolonged in allergic patients who received injection immunotherapy when compared to historical controls (one-sided P value < 0.05). However, after 1 year of immunotherapy, there was a significant reduction in SCTs in our patient population. This finding was independent of other evaluated patient characteristics, with the exception of nasal steroid use, which was also significantly associated with a decrease in SCT.

CONCLUSIONS

After 1 year of injection immunotherapy, there was a significant reduction in mean SCT in our patient population. Of the other factors studied, only nasal steroid was associated with decreased mucociliary clearance times. To our knowledge, this is the first report in the literature documenting the beneficial effect of injection immunotherapy on mucociliary clearance as measured by saccharin clearance times. Nevertheless, further research is warranted, given the confounding effect of nasal steroid use.

Distilled water nasal provocation in hyperreactive patients

Nonisotonic aerosol may act as a provocation agent in the upper and lower airways of hyperreactive individuals. The purpose of the study was to compare the results of nasal challenge with distilled water in patients with allergic rhinitis to those with noninfective nonallergic rhinitis (NINAR), with respect to the potential clinical use of the obtained data. A group of 68 ambulatory patients with allergic rhinitis or NINAR (39 perennial allergic, 6 seasonal, 23 NINAR) were challenged with 10 mL of distilled water aerosol after the baseline active anterior rhinomanometry. Patients with nasal polyposis at endoscopy, significant unilateral septal deviation, positive bacteriologic swab, recent nasal surgery, and uncertain anamnestic data about the medication taken 6 weeks before the provocation were excluded from the study. After 10 minutes of nasal provocation, rhinomanometry was repeated to assess the response. In 15 patients of the perennial allergic group, the same measurements were performed after a 2-week oral antihistamine and topical steroid therapy. Nasal resistance was significantly increased on the more patent side of the nose after nasal provocation with distilled water aerosol in allergic patients in comparison to the nasal resistance before provocation. In the patients with NINAR, the provocation resulted in a significant rise on the more patent side, but the total nasal airway resistance (NAR) levels were also significantly increased. The systemic antihistamine and topical steroid 2-week therapy in patients with perennial allergic rhinitis significantly reduced the response to nasal distilled water provocation. Nasal provocation with distilled water aerosol is a cheap, simple, and acceptable method that provides useful clinical data on the level of nonspecific nasal hyperreactivity and the therapy success.

Roxythromycin reinforces epithelial defence function in rabbit trachea

Our study elucidates the effect of roxythromycin (RXM) on airway epithelial defence functions, especially the mucociliary and epithelial barrier functions, in the rabbit trachea. In vitro ciliary activity was not affected in the presence of 3.3 mg/ml of RMX, but was enhanced in the presence of 6.7 mg/ml of RXM. Oral administration of 10 and 100 mg of RXM for 14 days enhanced both ciliary activity and mucociliary transport velocity in the trachea. Epithelial permeability to fluorescein isothiocyanate-dextrans (FD-70s; molecular weight: 70,000 daltons) was not affected by oral administration of 10 mg of RXM for 14 days, but was significantly reduced by oral administration of 100 mg of RXM for 14 days. Inhalation of platelet activating factor (PAF) compromised the function of the mucociliary system and the tight junction barrier. However, pretreatment with 20 mg of RXM significantly alleviated the PAF-induced decrease in mucociliary function and the increase in epithelial permeability to FD-70s. In conclusion, such reinforcement of the epithelial defence functions is likely to be involved in the pharmacological action underlying the clinical efficacy of RXM for chronic airway inflammatory disease.

Ten-year follow-up study of allergen-specific immunoglobulin E and immunoglobulin G4, soluble interleukin-2 receptor, interleukin-4, soluble intercellular adhesion molecule-1 and soluble vascular cell adhesion molecule-1 in serum of patients on immunotherapy for perennial allergic rhinitis

Recent double-blind placebo-controlled trials for perennial allergic rhinitis have all clearly shown the efficacy of immunotherapy. Although several mechanisms for the clinical efficacy of immunotherapy have been proposed, the exact mechanisms related to the clinical effect still remain unclear. Since immunotherapy is a form of systemic treatment and its clinical benefit is likely to be, at least in part, a consequence of its systemic effects on different phases of immunological events, our study focused exclusively on several immunological parameters in serum. A total of 47 patients with perennial allergic rhinitis due to Dermatophagoides farinae enrolled in this prospective study. Venous blood was collected for determination of specific immunoglobulin (Ig)E, specific IgG4, soluble interleukin-2 receptor (IL-2R), interleukin-4 (IL-4), soluble intercellular adhesion molecule-1 (ICAM-1) and soluble vascular cell adhesion molecule-1 (VCAM-1), six times from 20 untreated patients and 27 patients on immunotherapy, at enrolment, and 1, 2, 3, 5, and 10 years after enrollment. No specific IgE, IgG4, soluble IL-2R, IL-4 and soluble ICAM-1 levels changed significantly for a span of 10 years in the untreated patients. By contrast, immunotherapy affected serum levels of specific IgE, specific IgG4, soluble IL-2R, IL-4 and soluble ICAM-1, but not of soluble VCAM-1. The rates of increase in specific IgG4 and the rates of decrease in soluble IL-2R were correlated with the rates of decrease in symptom scores during the first 3 years, but not 5 and 10 years after the course of immunotherapy. On the other hand, the rates of decrease in specific IgE, IL-4 and soluble ICAM-1 were significantly correlated with the rates of decrease in symptom scores at 5 and 10 years, but not during the first 3 years. Each immunological modulation by immunotherapy was likely to be involved in the working mechanism related to clinical efficacy at different phases of immunotherapy.

Improvement of mucosal pathology of the sinuses after exposure to sulfur dioxide by nebulization of S-carboxymethylcysteine

Since s-carboxymethylcysteine (S-CMC) can directly enhance the ciliary activity in the maxillary sinus mucosa of patients with chronic sinusitis in the absence of significant organic changes of ciliated cells, the nebulization therapy using this medicine might be more effective in the treatment of chronic sinusitis than oral administration of the medicine. The safety of using 0.5-10% of S-SMC as a medicine for nebulization has been experimentally established. The present study was designed to experimentally examine the effectiveness of nebulization using 0.5-10% of S-CMC solution in the treatment of experimental chronic sinusitis in rabbits recurrently exposed to 20 ppm of sulfur dioxide. Thirty-three healthy rabbits were used; 3 of them were used as controls. The remaining 30 were exposed to 20 ppm of sulfur dioxide for 4 h a day for 4 successive weeks. Twelve animals were not treated with any medication during the post-exposure period, and sacrificed at 24 h or 15 days after completion of the final exposure to sulfur dioxide. The remaining 18 animals were treated with nebulization using 10%, 5% or 0.5% of S-CMC solution for 20 min a day for 14 successive days after the final exposure to sulfur dioxide, and they were sacrificed at 24 h after the final nebulization using S-CMC. At the time of sacrifice, the ciliary activity and the morphology of the sinus mucosa were observed to assess the effectiveness of S-CMC nebulization. In the animals sacrificed 24 h after the final exposure, the mucosa of the sinus demonstrated marked epithelial cell injuries, and the ciliary activity was extremely reduced. Complete recovery of the epithelium and the ciliary activity was not recognized in the animals sacrificed 15 days after completion of the exposure. By contrast, epithelial recovery was more accelerated in the animals treated with S-CMC nebulization during the 14 days after the exposure. In the animals treated with 0.5% of S-CMC, the ciliary activity was inferior to that of the control animals, and the epithelial repair was not complete. In the animals treated with 10% of S-CMC, however, ciliary activity and epithelial morphology were completely recovered. In conclusion, our study suggests that clinical application of 10% of S-CMC nebulization may provide otolaryngologists with a new tool in the treatment of sinus diseases such as chronic sinusitis.

Effect of immunotherapy on serum levels of eosinophil cationic protein in perennial allergic rhinitis

Eosinophil cationic protein (ECP) levels in the serum of clotted blood could reflect the rate of activation of circulating eosinophils. We investigated the serum ECP levels in patients with perennial allergic rhinitis, with special reference to the effect of immunotherapy on the serum ECP levels. Serum ECP levels in untreated patients with perennial allergic rhinitis are significantly higher than those of nonatopic volunteers. Therefore, this elevation in the untreated patients represents an ongoing inflammation occurring in allergic rhinitis. The mean serum ECP level of a 1-year immunotherapy group was significantly higher than that of the nonatopic group, and was not different from that of the untreated group. In contrast, the mean serum ECP level in patients who had more than 2 years of immunotherapy was significantly lower than that of the untreated group, and was not different from that of the nonatopic group. Additionally, serum ECP levels were significantly correlated with the duration of immunotherapy. These findings suggest that activation of circulating eosinophils decreases gradually during immunotherapy, but this inhibition becomes apparent only after 2 years of immunotherapy. The control of circulating eosinophil activation might be one of the important working mechanisms behind the clinical effect of immunotherapy.

Effect of immunotherapy on seasonal changes in serum-specific IgE and IgG4 in patients with pollen allergic rhinitis

Serum specific IgE and IgG4 in 70 patients with seasonal rhinitis caused by Japanese cedar pollens were determined before and during the pollen season. Seasonal increase rate in specific IgE was significantly smaller in the immunotherapy patients than the pharmacotherapy patients, and seasonal increase in specific IgG4 was significant in the immunotherapy patients only. Seasonal increase rate in specific IgE was not significantly different between the patients who responded markedly to short-term immunotherapy and those who did not. On the other hand, seasonal increase rate in specific IgG4 was significantly different between them. In contrast, seasonal increase rate in specific IgE was significantly smaller in the patients who showed marked response to the long-term immunotherapy than those who did not show marked response to the long-term immunotherapy, but seasonal increase rate in specific IgG4 was not significantly different between them. In conclusion, our results suggest that modulation of specific IgG4 response and specific IgE response might be involved in the early and late symptom relief during immunotherapy, respectively. However, further studies might be necessary to definitively establish the clinical roles of specific IgE and specific IgG4 in immunotherapy.

Natural course of serum-specific immunoglobulin E and immunoglobulin G4 for a span of eight years in untreated patients with perennial allergic rhinitis

During the past two decades, considerable attention has been devoted to the clinical role of serum-specific IgE and IgG4 following immunotherapy. To definitely discuss the clinical role of serum-specific IgG4, we should know the natural course of serum-specific IgG4 in the untreated patient with allergic rhinitis. To our knowledge, however, no such kind of study can be found in the literature. Our present study focused on the long-term follow-up of serum-specific IgE and IgG4 in patients who were not treated with immunotherapy for perennial allergic rhinitis. They were scheduled to take no medication for their perennial nasal symptoms for 8 years. Serum-specific IgE and IgG4 in untreated patients with perennial allergic rhinitis never significantly change during the observation period. These data will be of great value for studies in serologic changes following active treatment for atopic diseases. Additionally, our study suggests that a reduction in serum-specific IgE and an increase in serum-specific IgG4 following immunotherapy are not the result of an immunotherapy-independent and age-related phenomenon but the result of active immunologic modulation by immunotherapy.

Whole blood histamine release rate during immunotherapy for nasal allergy

In treating nasal allergies, desensitization is widely used on a daily basis, and its efficacy has been highly valued. With the purpose of predicting therapeutic efficacy before carrying out immunotherapy, we compared whole blood histamine release rate and various subjective symptoms before and after immunotherapy. We also compared the degrees of efficacy. Immunotherapy brought about a tendency for a reduction in the whole blood histamine release rate. This tendency appeared most marked in those patients in whom an improvement of subjective symptoms was considerable. Among subjective symptoms, the reduction in whole blood histamine release rate was strongest against nasal discharge and sneezing. In patients with a low histamine release rate prior to the initiation of immunotherapy, the improvement in subjective symptoms tended to be low.

Current concepts of mucociliary dysfunction in otitis media with effusion

From a survey of the literature on mucociliary function in the tubotympanum, it is clear that mucociliary activity and ciliary activity are deeply involved in the pathogenesis, pathology, and prognosis of otitis media with effusion. Ciliary function in the middle ear, especially in the tympanic orifice and the Eustachian tube, has an important role in the mucociliary clearance of surplus secretion to the pharynx. Our review demonstrates that ciliary activity in the tubotympanum is sensitive to a variety of pathological agents including bacteria, bacterial endotoxin, irritant gases, and irradiation, resulting in mucociliary dysfunction of the tubotympanum.