Experimental rhinovirus challenges in adults with mild asthma: Response to infection in relation to IgE
Experimental rhinovirus challenges in adults with mild asthma: Response to infection in relation to IgE
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DOI：
10.1067/mai.2003.1396
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发表时间：
2003-05-01
影响因子：
14.2
通讯作者：
Heymann, PW
中科院分区：
文献类型：
--
作者：
Zambrano, JC;Carper, HT;Heymann, PW
背景资料：虽然大多数儿童和年轻成人哮喘是特应性的，但哮喘的加重经常与病毒性呼吸道感染有关，特别是由鼻病毒（HRV）引起的病毒性呼吸道感染。目的：在实验性HRV感染之前和期间评估患有轻度哮喘的年轻特应性成人，以检验病毒接种前的气道炎症可能是HRV不良反应的危险因素的假设。在16名过敏性轻度哮喘志愿者和9名非特应性对照患者（年龄18 ~ 30岁）中评价了实验性HRV感染。在病毒接种前，每个参与者都进行了肺功能测试，皮肤点刺试验，常见的空气过敏原的致敏性，血清总IgE和血清中和抗体鼻病毒-16（用于接种的血清型）的测量。通过使用症状日记卡、肺功能测试以及鼻洗液、血液和呼气中的气道炎症标志物来监测对感染的反应，持续21天。结果：在感染期间，哮喘患者的累积上呼吸道和下呼吸道症状评分在21天内显着高于对照患者的评分。在基线时，哮喘患者对乙酰甲胆碱的敏感性也增加，FEV 1值（预测百分比）显著低于对照组患者（几何平均值和四分位数内值：哮喘患者为87% [79%至91%]，对照组为101% [90%至104%]，P <0.03）。在轻度哮喘患者中，6例血清总IgE水平显著升高（范围为371至820 IU/mL），而10例血清总IgE水平较低（范围为29至124 IU/mL）。在感染的最初4天内，高IgE组的下呼吸道症状评分显著高于低IgE组。他们在基线时的总血嗜酸性粒细胞计数也较高，鼻洗液中的嗜酸性粒细胞阳离子蛋白增加（>200 ng/mL），在基线和感冒症状高峰期呼出的一氧化氮水平增加。相比之下，可溶性细胞内粘附分子-1的哮喘患者的鼻洗液上清液中的IgE水平高的减少，无论是在基线和在infection.Conclusions：降低肺功能和增加炎症标记物的病毒接种前观察到的哮喘患者谁有高水平的血清总IgE可能是危险因素的不良反应与HRV感染。
Background: Although most children and young adults with asthma are atopic, exacerbations of asthma are frequently associated with viral respiratory tract infections, especially those caused by rhinovirus (HRV).Objective: Young atopic adults with mild asthma were evaluated before and during an experimental HRV infection to test the hypothesis that airway inflammation before virus inoculation may be a risk factor for an adverse response to HRV.Methods: Experimental HRV infections were evaluated in 16 allergic volunteers with mild asthma and 9 nonatopic control patients (age, 18 to 30 years). Before virus inoculation, each participant was screened with tests for lung function, prick skin tests for sensitization to common aeroallergens, measurements of total serum IgE, and serum neutralizing antibodly to rhinovirus-16 (the serotype used for inoculation). The response to infection was monitored for 21 days by using symptom diary cards, tests for lung function, and markers of airway inflammation in nasal washes, blood, and expired air.Results: During the infection, asthmatic patients had cumulative upper and lower respiratory tract symptom scores that were significantly greater over the course of 21 days than scores from the control patients. At baseline, the asthmatic patients also had increased sensitivity to methacholine and significantly lower values for FEV1 (percent predicted) than the control patients (geometric mean and intraquartile values: 87% [79% to 91%] for the asthmatic patients and 101% [90% to 104%] for the control patients, P < .03). Among the patients with mild asthma, 6 had levels of total serum IgE that were substantially elevated (range, 371 to 820 IU/mL) compared with 10 who had lower levels (range, 29 to 124 IU/mL). Those with high levels of IgE had significantly greater lower respiratory tract symptom scores during the initial 4 days of the infection than the low IgE group. They also had higher total blood eosinophil counts at baseline, increased eosinophil cationic protein in their nasal washes (>200 ng/mL), and augmented levels of expired nitric oxide at baseline and during peak cold symptoms. In contrast, levels of soluble intracellular adhesion molecule-1 in nasal wash supernatants from the asthmatic patients with high IgE were diminished, both at baseline and during the infection.Conclusions: The reduced lung function and increased markers of inflammation observed before virus inoculation in the asthmatic patients who had high levels of total serum IgE may be risk factors for an adverse response to infections with HRV.