Comparative responses to nasal allergen challenge in allergic rhinitic subjects with or without asthma

Marie-Claire Rousseau, Marie-Eve Boulay, Loie Goronfolah, Judah Denburg, Paul Keith, Louis-Philippe Boulet, Marie-Claire Rousseau, Marie-Eve Boulay, Loie Goronfolah, Judah Denburg, Paul Keith, Louis-Philippe Boulet

Abstract

Background: Nasal allergen challenge (NAC) is useful to study the pathophysiology of rhinitis, and multiple challenges may more adequately approximate natural exposure.

Objective: To determine the effect of 4 consecutive daily NAC, on clinical and inflammatory parameters in rhinitics with or without asthma.

Methods: Rhinitic subjects were recruited: 19 with mild asthma and 13 without asthma. Subjects underwent a control challenge (normal saline) followed by 4 consecutive daily NAC. Allergen challenge consisted of spraying the chosen allergen extract into each nostril until a positive nasal response occurred. Symptoms were recorded on a Likert scale, and oral peak expiratory and nasal peak inspiratory flows allowed assessment of a nasal blockage index (NBI), for a period of 7 hours. Induced sputum and nasal lavage were performed on control day and after 1 and 4 days of NAC.

Results: Compared with the control day, there was a significant increase in symptom scores and NBI 10 minutes after each last daily NAC in both groups (p < 0.05). Symptom scores and NBI were similar for the 2 groups, except for nasal obstruction and rhinorrhea, which were more marked in subjects with asthma and rhinitis, respectively. Nasal lavage eosinophils were increased after 4 days of challenges in both groups, but there was no change in sputum eosinophils. No cumulative effect or any late response were observed in any of the groups over the challenge period.

Conclusion: Multiple NAC may be a useful tool to study the pathophysiology of allergic rhinitis or its relationships with asthma.

Trial registration: ClinicalTrials.gov NCT01286129.

Figures

Figure 1
Figure 1
Study design. The protocol was divided into 3 different parts: a baseline visit, a control day (nasal challenge with 0.9% saline) and 4 consecutive days of nasal allergen challenge (days 1-4).
Figure 2
Figure 2
Effect of nasal challenge with saline (control day) or allergen (days 1-4) on NBI. (a) for rhinitics and (b) for asthmatics at 0 min and over 7 hours post-challenge. *p < 0.05; 0 min vs 10 min on days 1-4. **p < 0.05; Control day vs days 1-4.

References

    1. Bugiani M, Carosso A, Migliore E, Piccioni P, Corsico A, Olivieri M, Ferrari M, Pirina P, de Marco R. Allergic rhinitis and asthma comorbidity in a survey of young adults in Italy. Allergy. 2005;60:165–170. doi: 10.1111/j.1398-9995.2005.00659.x.
    1. Leynaert B, Neukirch C, Liard R, Bousquet J, Neukirch F. Quality of life in allergic rhinitis and asthma. Am J Respir Crit Care Med. 2000;162:1391–1396.
    1. Settipane RJ, Hagy GW, Settipane GA. Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students. Allergy Proc. 1994;15:21–25. doi: 10.2500/108854194778816634.
    1. Grossman J. One airway, one disease. Chest. 1997;111:11S–16S. doi: 10.1378/chest.111.2_Supplement.11S.
    1. Togias A. Rhinitis and asthma: evidence for respiratory system integration. J Allergy Clin Immunol. 2003;111:1171–1183. doi: 10.1067/mai.2003.1592.
    1. Rowe-Jones JM. The link between the nose and lung, perennial rhinitis and asthma- is it the same disease? Allergy. 1997;52(suppl.36):20–28.
    1. Day JH, Ellis AK, Rafeiro E, Ratz JD, Briscoe MP. Experimental models for the evaluation of treatment of allergic rhinitis. Ann Allergy Asthma Immunol. 2006;96:263–277. doi: 10.1016/S1081-1206(10)61235-5.
    1. Braunstahl GJ, Overbeek SE, Kleinjan A, Prins JB, Hoogsteden HC, Fokkens WJ. Nasal allergen provocation induces adhesion molecule expression and tissue eosinophilia in upper and lower airways. J Allergy Clin Immunol. 2001;107:469–476. doi: 10.1067/mai.2001.113046.
    1. Wilson AM, Duong M, Crawford L, Denburg J. An evaluation of peripheral blood eosinophil/basophil progenitors following nasal allergen challenge in patients with allergic rhinitis. Clin Exp Allergy. 2005;35:39–44. doi: 10.1111/j.1365-2222.2004.02072.x.
    1. de Bruin-Weller MS, Weller FR, De Monchy JG. Repeated allergen challenge as a new research model for studying allergic reactions. Clin Exp Allergy. 1999;29:159–165. doi: 10.1046/j.1365-2222.1999.00434.x.
    1. Ahlstrom-Emanuelsson C, Persson CG, Svensson C, Andersson M, Hosszu Z, Akerlund A, Greiff L. Establishing a model of seasonal allergic rhinitis and demonstrating dose-response to a topical glucocorticosteroid. Ann Allergy Asthma Immunol. 2002;89:159–165. doi: 10.1016/S1081-1206(10)61932-1.
    1. Andersson M, Svensson C, Persson C, Akerlund A, Greiff L. Dose-dependent effects of budesonide aqueous nasal spray on symptoms in a daily nasal allergen challenge model. Ann Allergy Asthma Immunol. 2000;85:279–283. doi: 10.1016/S1081-1206(10)62530-6.
    1. Korsgren M, Andersson M, Borga O, Larsson L, den-Raboisson M, Malmqvist U, Greiff L. Clinical efficacy and pharmacokinetic profiles of intranasal and oral cetirizine in a repeated allergen challenge model of allergic rhinitis. Ann Allergy Asthma Immunol. 2007;98:316–321. doi: 10.1016/S1081-1206(10)60876-9.
    1. Bousquet J, van Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108:S147–S334. doi: 10.1067/mai.2001.118891.
    1. ATS statement. Standardization of spirometry-1987 update. Am Rev Respir Dis. 1987;136:1285–1298.
    1. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J. Standardisation of spirometry. Eur Respir J. 2005;26:319–338. doi: 10.1183/09031936.05.00034805.
    1. Knudson RJ, Lebowitz MD, Holberg CJ, Burrows B. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis. 1983;127:725–734.
    1. Juniper EF, Cockcroft DW, Kolendowicz R. Histamine and methacholine inhalation test: a laboratory tidal breathing protocol. Astra Draco AB. 1994. pp. 1–49.
    1. Corren J, Adinoff AD, Irvin CG. Changes in bronchial responsiveness following nasal provocation with allergen. J Allergy Clin Immunol. 1992;89:611–618. doi: 10.1016/0091-6749(92)90329-Z.
    1. Youlten LJF. The peak nasal inspiratory flow meter: a new instrument for the assessment of the response to immunotherapy in seasonnal allergic rhinitis. Allergol Immunopathol. 1980;8:344.
    1. Taylor G, Macneil AR, Freed DL. Assessing degree of nasal patency by measuring peak expiratory flow rate through the nose. J Allergy Clin Immunol. 1973;52:193–198. doi: 10.1016/0091-6749(73)90057-2.
    1. Cormier Y, Laviolette M, Bedard G, Dosman J, Israel-Assayag E. Effect of route of breathing on response to exposure in a swine confinement building. Am J Respir Crit Care Med. 1998;157:1512–1521.
    1. Pin I, Gibson PG, Kolendowicz R. Use of induced sputum cell counts to investigate airway inflammation in asthma. Thorax. 1992;47:25–29. doi: 10.1136/thx.47.1.25.
    1. Pizzichini E, Pizzichini MMM, Efthimiadis A, Evans S, Morris MM, Squillace D, Gleich GJ, Dolovich J, Hargreave FE. Indices of airway inflammation in induced sputum: reproducibility and validity of cell and fluid-phase measurements. Am J Respir Crit Care Med. 1996;154:308–317.
    1. Wachs M, Proud D, Lichtenstein LM, Kagey-Sobotka A, Norman PS, Naclerio RM. Observations on the pathogenesis of nasal priming. J Allergy Clin Immunol. 1989;84:492–501. doi: 10.1016/0091-6749(89)90362-X.
    1. Boulay ME, Boulet LP. Influence of natural exposure to pollens and domestic animals on airway responsiveness and inflammation in sensitized non-asthmatic subjects. Int Arch Allergy Immunol. 2002;128:336–343. doi: 10.1159/000063856.
    1. Andersson M, Greiff L, Svensson C, Persson C. Various methods for testing nasal responses in vivo: a critical review. Acta Otolaryngol. 1995;115:705–713. doi: 10.3109/00016489509139391.
    1. Litvyakova LI, Baraniuk JN. Nasal provocation testing: a review. Ann Allergy Asthma Immunol. 2001;86:355–364. doi: 10.1016/S1081-1206(10)62478-7.
    1. Connell JT. Quantitative intranasal pollen challenge. II. Effect of daily pollen challenge, environmental pollen exposure, and placebo challenge on the nasal membrane. J Allergy. 1968;41:123–139. doi: 10.1016/0021-8707(68)90053-1.
    1. Connell JT. Quantitative intranasal pollen challenges. 3. The priming effect in allergic rhinitis. J Allergy. 1969;43:33–44. doi: 10.1016/0021-8707(69)90018-5.
    1. Sahin-Yilmaz AA, Naclerio RM. John T. Connell and nasal priming. J Allergy Clin Immunol. 2006;118:1190–1192. doi: 10.1016/j.jaci.2006.04.006.
    1. McDermott RA, Nelson HS, Dreskin SC. Mediator measurements after daily instillation of allergen: Increased IL-5 and decreased IFN-gamma. Allergy Asthma Proc. 2008;29:146–151. doi: 10.2500/aap.2008.29.3094.
    1. Pelikan Z. Late nasal response (LNR) - its clinical characteristics, feature, and possible mechanism(s) 1990. pp. 111–155.
    1. Reinartz SM, van Ree R, Versteeg SA, Zuidmeer L, van Drunen CM, Fokkens WJ. Diminished response to grass pollen allergen challenge in subjects with concurrent house dust mite allergy. Rhinology. 2009;47:192–198.

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