Chest
Volume 103, Issue 4, April 1993, Pages 1178-1184
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Clinical Investigations
Allergen-induced Recruitment of Inflammatory Cells in Lavage 3 and 24 h After Challenge in Allergic Asthmatic Lungs

https://doi.org/10.1378/chest.103.4.1178Get rights and content

To determine whether a link exists between the recruitment of inflammatory cells in the airways on a bronchial and bronchoalveolar level and the development of allergen-induced increase in bronchial hyperresponsiveness after allergen challenge, we used bronchial lavage and bronchoalveolar lavage to assess the airway responses to allergen. Twelve symptomatic atopic asthmatics were studied. In all patients bronchial and bronchoalveolar lavage was performed before, 3 h, and 24 h after allergen challenge. Monoclonal antibodies were used directed against T cells (CD3, CD4, CD8) and the eosinophil cationic protein (EG2). Eight patients showed a dual asthmatic response; four patients showed only an early asthmatic reaction after allergen challenge. Clear differences were found between bronchial and bronchoalveolar lavage. Activated eosinophils (EG2) were significantly increased both at 3 h (p = 0.01) and 24 h (p = 0.005). The number of activated eosinophils was significantly higher in the dual responders. A correlation was observed between the severity of the late asthmatic reaction (LAR) and the number of epithelial cells in the bronchial recovery at 3 h, but not at 24 h, in patients who clinically developed a LAR. No significant changes in the number of CD3, CD4, and CD8 cells 3 and 24 h after the challenge both in the bronchial and bronchoalveolar recovery were observed. We conclude that the number of activated eosinophils in bronchial lavage is associated with the development of the LAR and allergen-induced increase in bronchial hyperresponsiveness.

Section snippets

Subjects

Twelve allergic asthmatic subjects (six women, six men) participated in the study. The clinical characteristics of the patients are given in Table 1. All asthmatic subjects were selected on the basis of positive intracutaneous skin tests to common inhalant allergens, including Dermatophagoides pteronyssinus (Diephuis, Groningen, the Netherlands) and increased specific IgE (n<0.35 PRU/ml) for house dust mite (HDM) allergen (Phadezym RAST, Pharmacia, Uppsala, Sweden) and increased bronchial

Characteristics of the Study Population

In some subjects the HDM provocation resulted in a severe early and/or late reaction; however, intervention with medication was not needed. Four patients showed only an EAR after allergen challenge and eight patients developed a dual asthmatic response (Table 1). In all patients, measurements were within baseline values. All studied subjects tolerated the bronchoscopy procedure well. The procedure did not have to be terminated in any patient and none complained of distressing dyspnea. None of

DISCUSSION

This study was designed to explore lavage findings between a steady-state period, 3 h and 24 h after a HDM challenge in single and dual asthmatic responders using BL and BAL. The number of activated (EG2)eosinophils was significantly increased at 3 h, but not the percentage of eosinophils. At 24 h both the percentage of eosinophils and the number of activated (EG2)eosinophils were increased, and at 24 h a good correlation between activated eosinophils and the percentage of eosinophils was

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    Supported by Grant No 84.41 from the Nederlands Astma Fonds and a grant from DRACO AB, Lund, Sweden.

    Manuscript received May 7; revision accepted August 19

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