Clinical and nasal irrigation fluid findings in perennial allergic rhinitis

Serum and local IL-4, IL-5, IL-13 and immunoglobulin E in allergic rhinitis

Introduction

Allergic rhinosinusitis (AR) is a clinical manifestation of a type 1 hypersensitive reaction. A complex of reactions involving components of the immune system – cells, mediators, cytokines, neuropeptides, adhesion molecules etc., are involved in the manifestation of the disease symptoms.

Aim

To evaluate the role of some serum and local cytokines and IgE molecules in the pathogenesis of AR comparing results in patients and healthy controls.

Material and methods

The study was conducted at the Prof. Dr. St. Kirkovich University Hospital and Medical University, Stara Zagora, Bulgaria.

Results

A trend towards higher serum levels in patients with AR compared to controls was found for IL-4, but with no significant difference. In the group of AR patients, those with the intermittent form had higher, although with no significance, interleukin 4 (IL-4) levels in the lavage compared to those with the persistent form. In nasal lavage fluids a tendency towards higher IL-5 levels was found in intermittent AR patients compared to those with persistent AR. A slight trend towards significantly higher serum levels of IL-13 in overweight patients compared to those with normal weight was found.

Conclusions

Regardless of the obvious differences of the concentrations of the cytokines studied in our groups, oftentimes no significant difference is observed. More studies should be conducted in order to show the role of IL-4, -5, -13, and IgE in the pathogenesis and severity of the disease.

Tryptase as an inflammatory marker in allergic disease and asthma

Asthma is a chronic inflammatory disease of the airways, varying from occasional episodes of wheezing and shortness of breath, to an irreversible, life-threatening obstructive disease. While many cases are managed with relative ease, others do not respond to the traditional inhaled therapy or even to oral glucocorticosteroids. Although it cannot be cured as yet, asthma can be controlled if properly diagnosed. Usually, functional clinical parameters form the basis for estimation of the disease severity. In addition, the growing database of cytokine and mediator profiles have allowed their exploitation as molecular markers for processes underlying airway inflammation in asthma. Tryptase is a potent and versatile mediator in allergic inflammation, orchestrating both acute and chronic events by acting on a vast array of cells and tissue components. For more than a decade, tryptase has been used as a marker for allergic inflammation in asthma as well as in a variety of other airway diseases. In this review, the current advantages and disadvantages of the use of tryptase as an inflammatory marker in asthma will be discussed.

Nasal carriage of Staphylococcus aureus in house dust mite allergic patients and healthy controls

BACKGROUND

Staphylococcal colonization may influence the course of allergic diseases such as atopic dermatitis or allergic rhinitis. The frequency of Staphylococcus aureus (SA) nasal carriage and its possible influence on persistent allergic rhinitis was investigated.

METHODS

In nasal lavages from 22 patients with house dust mite allergy and 18 healthy controls, the number of SA colony forming units per ml were assessed and related to nasal symptom scores, the concentrations of three inflammatory cell activation markers, nasal total IgE and 17 cytokines in nasal secretions.

RESULTS

SA was found in 15/22 allergic patients and 4/18 controls (P < 0.01). Comparing allergic SA carriers with allergic noncarriers, nasal symptom scores tended to be higher (P < 0.1), and the cell activation markers ECP (10(2.23+/-0.33)vs 10(1.45+/-0.50) ng/ml; P < 0.05) and elastase (10(2.70+/-0.21)vs 10(2.12+/-0.34) ng/ml; P < 0.01), and nasal total IgE-levels (10(1.66+/-0.38)vs 10(1.2+/-0.28) kU/ml; P < 0.05) were significantly higher in allergic SA carriers. Nasal SA carriers had a higher nasal IL-13/IFN-gamma ratio (P < 0.01), and this was correlated with higher nasal total IgE in allergic patients (r = 0.6, P < 0.05).

CONCLUSION

Nasal SA carriage is frequent in patients with persistent allergic rhinitis. The data of this study suggest that they are not only secondary bystanders, but actively modulate the disease by promoting local IgE production.

The effect of budesonide on the cytokine pattern in patients with perennial allergic rhinitis

BACKGROUND

A T(H)2-polarized cytokine pattern has been demonstrated in allergic rhinitis. Budesonide represents an effective topical corticosteroid in the management of allergic rhinitis.

OBJECTIVE

To evaluate cytokine pattern and symptoms in patients with perennial allergic rhinitis before and after treatment with intranasal budesonide.

METHODS

All patients received budesonide aqueous nasal spray or placebo for 2 weeks. The study was double-blind, parallel group, placebo controlled, and randomized. Nasal lavage was performed in all patients before and after treatment. A panel of cytokines, including interleukin 4 (IL-4), IL-5, and IL-6, was measured by immunoassay on fluids recovered from nasal lavage. Total symptom score (including rhinorrhea, nasal itching, sneezing, and nasal obstruction) was evaluated before and after treatment.

RESULTS

Twenty patients with perennial allergic rhinitis were evaluated (13 men and 7 women; mean age, 24.7 years). Budesonide aqueous nasal spray treatment showed a significant decrease of IL-4 (P = .007), IL-5 (P = .04), and IL-6 levels (P = .009). Budesonide aqueous nasal spray treatment also induced significant symptom relief (P = .006). Placebo treatment did not significantly affect the evaluated parameters.

CONCLUSIONS

This study shows that budesonide aqueous nasal spray is effective in exerting immunomodulatory activity by reducing cytokine pattern and relieving symptoms. These findings are evidence of the effects of intranasal budesonide in treating perennial allergic rhinitis.

Repeatability and validity of cell and fluid-phase measurements in nasal fluid: a comparison of two methods of nasal lavage

BACKGROUND

There is little information on the repeatability of cell counts and fluid-phase measurements in nasal fluid obtained by different methods of nasal lavage.

OBJECTIVE

To compare the repeatability and validity of total and differential cell counts and eosinophil cationic protein (ECP) in nasal secretions obtained by two methods of nasal lavage.

PATIENTS AND METHODS

Twelve healthy subjects and twelve subjects with clinically stable allergic rhinitis were randomly assigned to two nasal lavages (separated by 48 h), by one of two methods in the first week and by the second method in the following week. One method was a modification of the method described by Greiff et al. and Grunberg and coworkers and the other was that described by Naclerio and coworkers.

RESULTS

Both methods of nasal lavage gave poorly repeatable eosinophil counts and ECP in normal subjects but better repeatability in subjects with rhinitis. The modified Greiff/Grunberg method gave higher and more repeatable total cell count and, in subjects with rhinitis, more reproducible ECP levels compared with the Naclerio

METHOD

Both methods were able to discriminate between healthy and rhinitic subjects: mean +/- SD eosinophil percentage count and eosinophil cationic protein differences were 4.5 +/- 4% (P < 0.05) and 24.5 +/- 46.9 microg/L (P < 0.05), respectively, with the modified method and 7.0 +/- 4% (P < 0.05) and 26.9 +/- 68 microg/L (P < 0.05), respectively, with the Naclerio method.

CONCLUSION

Both methods are valid and discriminate between normal and rhinitic subjects. In subjects with rhinitis, although the repeatability of eosinophil counts is similar by both methods, the modified Greiff/Grunberg method gives more reproducible ECP measurements, compared with the Naclerio method.

Changes in nasal leukocytes and epithelial cells associated with topical beclomethasone treatment

BACKGROUND

We had previously observed that changes in nasal cytology were associated with specific clinical patterns in cross-sectional studies of allergy clinic patients. In the present study, we sought to determine whether specific cytologic changes occurred with antiinflammatory therapy in a controlled setting in a prospective manner.

OBJECTIVE

To examine changes in nasal leukocytes and epithelial cells associated with topical beclomethasone treatment in allergic rhinitis patients. Specifically we tested the hypothesis that number of nasal leukocytes relative to epithelial cell numbers are altered by topical beclomethasone treatment.

METHODS

Adult volunteers (n=26) with symptoms consistent with allergic rhinitis and positive aeroallergen skin tests were enrolled for treatment with either beclomethasone or placebo nasal spray. Sprays were allocated in a double-blind manner and were prescribed to be administered over a 2-week period. Baseline quality of life, nasal cytograms, and mucosal physical appearance scores were obtained at baseline and at the end of the treatment period. Changes in various nasal leukocytes and epithelial cell types were analyzed for association with active treatment using bivariate and multivariate analysis.

RESULTS

Total leukocytes showed greater decreases with beclomethasone treatment than with placebo. Total epithelial cells on the other hand showed an increase with active treatment compared with placebo treatment. In multivariate analysis, the changes in both total leukocytes and total epithelial cells showed independent associations with beclomethasone treatment. Combining these two variables into a single leukocyte per epithelial ratio resulted in variable with values showing a significant decreases associated with beclomethasone treatment compared with placebo treatment (P = .03).

CONCLUSIONS

The administration of topical corticosteroids results in decreases in total leukocytes and this decrease is of enhanced significance when adjusted for the quantities of associated epithelial cells. Further investigation relating to the quantities of total nasal leukocytes in inflammatory nasal diseases may be helpful in gauging disease activity and monitoring treatment modalities.