A comparison of the airway response to segmental antigen bronchoprovocation in atopic asthma and allergic rhinitis
A comparison of the airway response to segmental antigen bronchoprovocation in atopic asthma and allergic rhinitis
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DOI：
10.1067/mai.2003.28
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发表时间：
2003-01-01
影响因子：
14.2
通讯作者：
Jarjour, NN
中科院分区：
文献类型：
--
作者：
Kelly, EAB;Busse, WW;Jarjour, NN
背景：变应性哮喘患者和变应性鼻炎（无哮喘）患者具有许多相同的免疫病理特征，但在对抗原的反应中存在下气道症状方面有所不同。目的：我们试图比较特应性哮喘和变应性鼻炎患者对抗原的气道炎症反应。方法：对9例特应性哮喘患者和9例非哮喘变应性鼻炎患者行生理盐水或豚草抗原段性支气管刺激。在段性支气管刺激中使用的抗原剂量是吸入刺激导致FEV1减少20%的剂量的10%。在刺激后5分钟和48小时分别对生理盐水和抗原刺激段进行支气管肺泡灌洗（BAL）。分析BAL液的细胞计数和差异、淋巴细胞分布和可溶性因子（组胺、IL-5、基质金属蛋白酶9、金属蛋白酶1组织抑制剂和纤维连接蛋白）的浓度。此外，体外培养BAL细胞，测定IL-5、ifn - γ和IL-10的生成。结果：抗原激发导致两组相似的细胞募集模式、中介水平和BAL细胞因子的产生；然而，在哮喘患者中，促进气道类似反应所需的抗原剂量明显较少。结论：这些数据提示，过敏原引起的急性气道炎症模式本身并不能解释抗原诱导的下气道阻塞和哮喘症状。我们推测，其他因素，如气道对过敏原的敏感性增加或先前存在的气道损伤和重塑，可能解释为什么哮喘和鼻炎患者对抗原暴露的临床和生理反应不同。
Background: Patients with allergic asthma and those with allergic rhinitis (without asthma) share many immunopathologic features but differ in the presence of lower airway symptoms in response to antigen.Objectives: We sought to compare the airway inflammatory response to antigen in patients with atopic asthma and allergic rhinitis.Methods: Segmental bronchoprovocation with saline or ragweed antigen was performed in 9 patients with atopic asthma and 9 patients with allergic rhinitis without asthma. The antigen dose used in segmental bronchoprovocation was 10% of the dose that caused a 20% decrease in FEV1 in response to inhalation challenge. Bronchoalveolar lavage (BAL) was performed from the saline- and antigen-challenged segments at 5 minutes and 48 hours after challenge. BAL fluid was analyzed for cell count and differential, distribution of lymphocytes, and concentration of soluble factors (histamine, IL-5, matrix metalloproteinase 9, tissue inhibitor of metalloproteinase 1, and fibronectin). In addition, BAL cells were cultured ex vivo, and IL-5, IFN-gamma, and IL-10 generation was measured.Results: Antigen challenge led to similar patterns of cellular recruitment, mediator levels, and BAL cell cytokine generation in both groups; however, the dose of antigen required to promote comparable responses in the airway was significantly less in patients with asthma.Conclusion: These data suggest that the pattern of acute airway inflammation in response to allergen does not by itself explain antigen-induced lower airway obstruction and asthma symptoms. We speculate that other factors, such as increased airway sensitivity to allergen or preexisting airway injury and remodeling, might explain why patients with asthma and rhinitis differ in their clinical and physiologic response to antigen exposure.