Unilateral nasal allergic reactions increase bilateral sinus eosinophil infiltration

Abstract

We have previously shown that unilateral nasal challenge with antigen causes an increase in the number of eosinophils in the ipsilateral maxillary sinus. Here we aimed to determine whether there was an eosinophil response in the contralateral maxillary sinus after unilateral nasal challenge with antigen. Twenty subjects with a history of seasonal allergic rhinitis and a positive nasal challenge to ragweed or grass allergens were studied outside of their allergy season. Catheters were placed in both maxillary sinuses and the subjects were challenged with antigen via the left nostril. The subjects recorded nasal symptoms before and after each allergen challenge and hourly for 8 h afterward. We performed nasal lavages of the nose and sinuses at the same time as symptoms were recorded. The lavages were analyzed for the number of eosinophils and levels of albumin. Subjects showed a symptomatic response to challenge accompanied by an influx of eosinophils into the nose and increased vascular permeability. The number of eosinophils increased in both maxillary sinuses. The total change from diluent in eosinophils during the late phase response was higher in the ipsilateral maxillary sinus (median = 8,505; range = 0-100,360) compared with the contralateral sinus (median = 1,596; range = -13,527-93,373; P = 0.03). We conclude that eosinophils increase in both maxillary sinuses after unilateral nasal challenge. We speculate that a central neurologic reflex initiated in the nose by the nasal challenge contributes to the bilateral eosinophil response in the maxillary sinuses. We further speculate that, since there are more eosinophils in the ipsilateral compared with the contralateral maxillary sinus, there is also an axonal reflex into the ipsilateral maxillary sinus that contributed to the eosinophil response.

Keywords: eosinophils; maxillary sinus; nasal allergen challenge.

Figures

Fig. 1.

Sneezes and symptoms of rhinorrhea, congestion, and itchy nose after nasal allergen challenge. The x-axis depicts the challenge protocol: Base, baseline; Dil, diluent for the allergen extract; Ag, ragweed or grass allergen extracts at increasing concentrations; hr, hour after the last allergen challenge. Median responses for 20 subjects are depicted. There was a significant increase in sneezes and symptom scores for rhinorrhea, congestion, and itchy nose after allergen compared with diluent during the early and late phase responses. *P ≤ 0.05 and †P < 0.01 vs. diluent challenge.

Fig. 2.

Total nasal symptoms (rhinorrhea, congestion, and itchy nose) after nasal allergen challenge. The x-axis depicts the challenge protocol: Base, baseline; Dil, diluent for the allergen extract; Ag, ragweed or grass allergen extracts at increasing concentrations; hr, hour after the last allergen challenge. Median responses for 20 subjects are depicted. There was a significant increase in total nasal symptoms after allergen compared with diluent during both the early and late phase response. *P ≤ 0.05 vs. diluent challenge.

Fig. 3.

Eosinophils in nasal secretions after nasal allergen challenge. The x-axis depicts the challenge protocol: Base, baseline; Dil, diluent for the allergen extract; Ag, ragweed or grass allergen extracts at increasing concentrations; hr, hour after the last allergen challenge. The y-axis depicts the total number of eosinophils recovered in each nasal lavage. Median responses for 20 subjects are depicted. There was a significant increase in the number of eosinophils after allergen compared with diluent after the third allergen challenge and Hours 2–8 of the late phase response. * P ≤ 0.05 vs. diluent challenge.

Fig. 4.

Eosinophils in ipsilateral and contralateral maxillary sinus secretions after nasal allergen challenge. The x-axis depicts the challenge protocol: Base, baseline; Dil, diluent for the allergen extract; Ag, ragweed or grass allergen extracts at increasing concentrations; hr, hour after the last allergen challenge. The y-axis depicts the total number of eosinophils recovered in each nasal lavage. Median responses for 20 subjects are depicted. There was a significant increase in the number of eosinophils compared with diluent at different time points after nasal allergen challenge in both the ipsilateral and contralateral sinus cavities. *P ≤ 0.05 vs. diluent challenge.

Fig. 5.

Levels of albumin in nasal secretions after nasal allergen challenge. The x-axis depicts the challenge protocol: Base, baseline; Dil, diluent for the allergen extract; Ag, ragweed or grass allergen extracts at increasing concentrations; hr, hour after the last allergen challenge. Median responses for 20 subjects are depicted. There was a significant increase in albumin after allergen compared with diluent during both the early and late phase responses. *P ≤ 0.05 vs. diluent challenge.

Fig. 6.

Levels of albumin in ipsilateral and contralateral maxillary sinus secretions after nasal allergen challenge. The x-axis depicts the challenge protocol: Base, baseline; Dil, diluent for the allergen extract; Ag, ragweed or grass allergen extracts at increasing concentrations; hr, hour after the last allergen challenge. Median responses for 20 subjects are depicted. There was a significant increase in levels of albumin compared with diluent at different time points after nasal allergen challenge in both the ipsilateral and contralateral sinus cavities. *P ≤ 0.05 and **P ≤ 0.01 vs. diluent challenge.