Demonstration of bronchial eosinophil activity in seasonal allergic rhinitis by induced plasma exudation combined with induced sputum
a Department of
Otorhinolaryngology, Head & Neck Surgery, b Department of
Clinical Pharmacology, c University Hospital, S-221 85 Lund, Sweden
Department of Clinical Physiology, University
Hospital, Malmö, Sweden, d Department of Research & Development, Astra
Draco, Lund, Sweden
Correspondence to: Dr L Greiff.
Received 20 April 1998; Returned to authors 29 June 1998; Revised version received 14 August 1998; Accepted for publication 1 September 1998
BACKGROUND
Patients
with seasonal allergic rhinitis may develop bronchial
hyperresponsiveness during the active disease period. Eosinophil activation may occur in the bronchial mucosa and may be reflected by
increased sputum levels of eosinophil cationic protein (ECP), especially when ECP binding proteins such as
2-macroglobulin pass through the lamina propria and
across the epithelium into the airway lumen. A study was therefore
undertaken to determine histamine airway responsiveness
(FEV1) and bronchovascular responsiveness (exudation of
2-macroglobulin) to histamine in subjects with seasonal
allergic rhinitis, and to explore whether sputum ECP levels are
increased by the use of induced exudation followed by induced sputum.
METHODEleven patients
with seasonal allergic rhinitis were examined before and during a birch
pollen season. Sputum was induced by inhalation of 4.5% saline twice
before and twice during the pollen season. Histamine inhalations were
given before the second of each pair of sputum inductions at increasing
concentrations until FEV1 was reduced by 20%. Sputum
levels of 2-macroglobulin and ECP were determined as
indices of bronchial exudation of plasma and activation of bronchial
eosinophils, respectively.
RESULTSBronchomotor
responsiveness increased during the pollen season (median difference in
the reduction of FEV1 9% (95% confidence interval (CI)
-3 to 26)) but histamine induced exudation of plasma was not
increased. Baseline sputum levels of 2-macroglobulin and
ECP did not increase. Histamine induced exudation of
2-macroglobulin was associated with increased sputum
levels of ECP exclusively during the pollen season (median difference
8.2 ng/ml (95% CI 0.4 to 562.0)).
CONCLUSIONBronchial
hyperresponsiveness in seasonal allergic rhinitis may not be associated
with bronchovascular exudative hyperresponsiveness. Sputum levels of
ECP were increased only during the season, and only after induced
exudation (potentially moving ECP to the mucosal surface). It is
suggested that the combined method of induced exudation and induced
sputum may significantly improve the yield of some markers of
inflammation in sputum samples.
2-macroglobulin;
asthma;
ECP;
histamine;
induced sputum;
plasma exudation
© 1999 by Thorax
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